Provider Demographics
NPI:1275806002
Name:LEVERETT, FLECELIA RENEE
Entity Type:Individual
Prefix:
First Name:FLECELIA
Middle Name:RENEE
Last Name:LEVERETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N REDMOND AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3447
Mailing Address - Country:US
Mailing Address - Phone:405-408-0958
Mailing Address - Fax:
Practice Address - Street 1:3700 N REDMOND AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3447
Practice Address - Country:US
Practice Address - Phone:405-408-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation