Provider Demographics
NPI:1598938771
Name:FLEMING, SHANNA MAUREEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:MAUREEN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3242
Mailing Address - Country:US
Mailing Address - Phone:707-769-4450
Mailing Address - Fax:
Practice Address - Street 1:100 VALLEJO ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-3242
Practice Address - Country:US
Practice Address - Phone:707-769-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27164106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist