Provider Demographics
NPI:1922303619
Name:FLESHER, MITCHELL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:R
Last Name:FLESHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8629 BLUEJACKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1604
Mailing Address - Country:US
Mailing Address - Phone:913-220-3282
Mailing Address - Fax:
Practice Address - Street 1:8629 BLUEJACKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66214-1604
Practice Address - Country:US
Practice Address - Phone:913-220-3282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP 1223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical