Healthcare Provider Details

I. General information

NPI: 1366526097
Provider Name (Legal Business Name): FLEMING PSYCHOLOGICAL SERVICES, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 GREEN BAY RD STE. 230
KENOSHA WI
53142-2926
US

IV. Provider business mailing address

6121 GREEN BAY RD STE. 230
KENOSHA WI
53142-2926
US

V. Phone/Fax

Practice location:
  • Phone: 262-654-8366
  • Fax: 262-842-0444
Mailing address:
  • Phone: 262-654-8366
  • Fax: 262-842-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ANN M. FLEMING
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: MSW, LCSW
Phone: 262-654-8366