Provider Demographics
NPI:1235635152
Name:FLEMING, MARK EVAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EVAN
Last Name:FLEMING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 COLTON BLUFF SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-7205
Mailing Address - Country:US
Mailing Address - Phone:512-674-1385
Mailing Address - Fax:
Practice Address - Street 1:5828 BALCONES DR STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4279
Practice Address - Country:US
Practice Address - Phone:512-674-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX567911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical