Provider Demographics
NPI:1437690492
Name:MELISSA PETERSON FLEMING
Entity Type:Organization
Organization Name:MELISSA PETERSON FLEMING
Other - Org Name:MELISSA FLEMING, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-507-9169
Mailing Address - Street 1:277 CULLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2830
Mailing Address - Country:US
Mailing Address - Phone:512-507-9169
Mailing Address - Fax:
Practice Address - Street 1:8101 W HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8103
Practice Address - Country:US
Practice Address - Phone:512-507-9169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03198825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX03198825OtherLICENSE NUMBER