Provider Demographics
NPI:1316925100
Name:FLEMING, MARK CHRISTOPHER (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:FLEMING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6358
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6358
Mailing Address - Country:US
Mailing Address - Phone:410-441-0105
Mailing Address - Fax:314-919-9668
Practice Address - Street 1:950 W ELLIOT RD
Practice Address - Street 2:SUITE 220
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1144
Practice Address - Country:US
Practice Address - Phone:410-441-0105
Practice Address - Fax:314-919-9668
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000704103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038968Medicaid
DE213021OtherCOMPSYCH CORPORATION