Provider Demographics
NPI:1144610957
Name:DR MICHAEL FLETCHER PSYD LCPC
Entity Type:Organization
Organization Name:DR MICHAEL FLETCHER PSYD LCPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-219-9286
Mailing Address - Street 1:425 W MEADOW MIST LN
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-4271
Mailing Address - Country:US
Mailing Address - Phone:847-219-9286
Mailing Address - Fax:
Practice Address - Street 1:8700 SKOKIE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2279
Practice Address - Country:US
Practice Address - Phone:847-673-8577
Practice Address - Fax:847-568-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009405251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health