Provider Demographics
NPI:1366526097
Name:FLEMING PSYCHOLOGICAL SERVICES, SC
Entity type:Organization
Organization Name:FLEMING PSYCHOLOGICAL SERVICES, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:262-654-8366
Mailing Address - Street 1:6121 GREEN BAY RD
Mailing Address - Street 2:STE. 230
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-2926
Mailing Address - Country:US
Mailing Address - Phone:262-654-8366
Mailing Address - Fax:262-842-0444
Practice Address - Street 1:6121 GREEN BAY RD
Practice Address - Street 2:STE. 230
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-2926
Practice Address - Country:US
Practice Address - Phone:262-654-8366
Practice Address - Fax:262-842-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty