Provider Demographics
NPI:1699188045
Name:FLETCHER, AMIEL LATOUR
Entity Type:Individual
Prefix:MR
First Name:AMIEL
Middle Name:LATOUR
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E ADA SIPUEL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-1910
Mailing Address - Country:US
Mailing Address - Phone:405-320-2536
Mailing Address - Fax:
Practice Address - Street 1:401 E ADA SIPUEL AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-1910
Practice Address - Country:US
Practice Address - Phone:405-320-2536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health