Provider Demographics
NPI:1093019937
Name:NEVINS, FLEETA RENEE (PHD HSPP)
Entity Type:Individual
Prefix:DR
First Name:FLEETA
Middle Name:RENEE
Last Name:NEVINS
Suffix:
Gender:F
Credentials:PHD HSPP
Other - Prefix:DR
Other - First Name:FLEETA
Other - Middle Name:RENEE
Other - Last Name:VAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1806 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2243
Mailing Address - Country:US
Mailing Address - Phone:765-381-4578
Mailing Address - Fax:
Practice Address - Street 1:1806 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2243
Practice Address - Country:US
Practice Address - Phone:765-381-4578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042460A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist