Provider Demographics
NPI:1518605633
Name:FLETCHER, SAMEDRA
Entity Type:Individual
Prefix:
First Name:SAMEDRA
Middle Name:
Last Name:FLETCHER
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 1:7505 PINES RD STE 1160
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71129-3924
Mailing Address - Country:US
Mailing Address - Phone:318-703-4779
Mailing Address - Fax:318-918-1258
Practice Address - Street 1:7505 PINES RD STE 1160
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3924
Practice Address - Country:US
Practice Address - Phone:318-703-4779
Practice Address - Fax:318-918-1258
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst