MEDICARE: JIMMY L FLEMING LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2585	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2585	OTHER	OK	LICENSE

General Provider Information

NPI Number	:	1093933517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY L FLEMING LPC

Provider Business Mailing Address
First Line	:	10405 GREENBRIAR PL STE A-2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7636
Country	:	US
Telephone Number	:	405-613-6889
Fax Number	:

Provider Business Practice Location Address
First Line	:	10405 GREENBRIAR PL STE A-2
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7636
Country	:	US
Telephone Number	:	405-613-6889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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