Provider Demographics
NPI:1316588437
Name:FLEURY, CARRIE LYN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYN
Last Name:FLEURY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1647 CHAMPAGNE AVE
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9039
Mailing Address - Country:US
Mailing Address - Phone:210-412-5803
Mailing Address - Fax:
Practice Address - Street 1:1647 CHAMPAGNE AVE
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9039
Practice Address - Country:US
Practice Address - Phone:210-412-5803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional