Provider Demographics
NPI:1316269475
Name:FLETCHER, MARK B (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:B
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
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Mailing Address - Street 1:1401 LAKEWOOD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3352
Mailing Address - Country:US
Mailing Address - Phone:815-942-6323
Mailing Address - Fax:815-942-6423
Practice Address - Street 1:210 N HAMMES AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6680
Practice Address - Country:US
Practice Address - Phone:815-942-6323
Practice Address - Fax:815-942-6423
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL178006509101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health