Provider Demographics
NPI:1073819934
Name:FLEMING, STEPHANIE LYNN (LMHC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 AIRPORT DR
Mailing Address - Street 2:G17
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-4775
Mailing Address - Country:US
Mailing Address - Phone:850-212-6737
Mailing Address - Fax:
Practice Address - Street 1:1331 AIRPORT DR
Practice Address - Street 2:G17
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-4775
Practice Address - Country:US
Practice Address - Phone:850-212-6737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11779101YP2500X, 101YM0800X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth