Provider Demographics
NPI:1972923415
Name:FLEMINGS, NATASHA VENESSA (MS, LLP, LBA, BCBA)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:VENESSA
Last Name:FLEMINGS
Suffix:
Gender:F
Credentials:MS, LLP, LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1899
Mailing Address - Country:US
Mailing Address - Phone:810-227-1344
Mailing Address - Fax:
Practice Address - Street 1:100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1899
Practice Address - Country:US
Practice Address - Phone:810-227-1344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007965103T00000X
MI7401000982103K00000X
1-14-15741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist