Provider Demographics
NPI:1477761971
Name:FLEMONS, DOUGLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:FLEMONS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 E SUNRISE BLVD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1479
Mailing Address - Country:US
Mailing Address - Phone:954-296-8944
Mailing Address - Fax:
Practice Address - Street 1:1948 E SUNRISE BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1479
Practice Address - Country:US
Practice Address - Phone:954-296-8944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ8126OtherBCBS PROVIDER