Provider Demographics
NPI:1306293139
Name:FLEMING, MELISSA DARLENE (MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DARLENE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:DARLENE
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:8101 W HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8103
Mailing Address - Country:US
Mailing Address - Phone:512-507-9169
Mailing Address - Fax:
Practice Address - Street 1:277 CULLEN BLVD
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2830
Practice Address - Country:US
Practice Address - Phone:512-507-9169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03198825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional