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General NPI Number Information
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NPI Number | 1013314988
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Entity Type | Individual
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Provider Name | MARY JO FLEMING M.A. PROFESSIONAL CO
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Gender | Female
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 919 12TH PLACE STE 13 RECOVERY IN THE PINES
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-227-2967
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Fax |
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Provider Business Mailing Address
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Address Line | 919 12TH PLACE STE 13 RECOVERY IN THE PINES
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-227-2967
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Fax | 928-227-2968
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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