Provider Demographics
NPI:1780865840
Name:FLETCHER, JEFFREY KYLE (MA)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:KYLE
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W CAMPBELL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3601
Mailing Address - Country:US
Mailing Address - Phone:972-322-5050
Mailing Address - Fax:972-671-3102
Practice Address - Street 1:275 W CAMPBELL RD
Practice Address - Street 2:SUITE 121
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3601
Practice Address - Country:US
Practice Address - Phone:972-322-5050
Practice Address - Fax:972-671-3102
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health