Provider Demographics
NPI:1851589139
Name:FLEMING, JOHN C (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:FLEMING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:LAVA HOT SPRINGS
Mailing Address - State:ID
Mailing Address - Zip Code:83246-0404
Mailing Address - Country:US
Mailing Address - Phone:801-635-7029
Mailing Address - Fax:
Practice Address - Street 1:165 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LAVA HOT SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83246
Practice Address - Country:US
Practice Address - Phone:801-635-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5930941-35021041C0700X
IDLCSW-290111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical