Healthcare Provider Details

I. General information

NPI: 1508771353
Provider Name (Legal Business Name): PETRA LEE FLEMMER QMHA-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 W ADAMS ST
BURNS OR
97720-1710
US

IV. Provider business mailing address

PO BOX 662
HINES OR
97738-0662
US

V. Phone/Fax

Practice location:
  • Phone: 541-573-8376
  • Fax:
Mailing address:
  • Phone: 541-578-8376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number26-QMHA-R-9098
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: