Provider Demographics
NPI:1093933517
Name:FLEMING, JIMMY L (LPC)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:L
Last Name:FLEMING
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10405 GREENBRIAR PL STE A-2
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7636
Mailing Address - Country:US
Mailing Address - Phone:405-613-6889
Mailing Address - Fax:
Practice Address - Street 1:10405 GREENBRIAR PL STE A-2
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7636
Practice Address - Country:US
Practice Address - Phone:405-613-6889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2585OtherLICENSE