Provider Demographics
NPI:1013314988
Name:FLEMING, MARY JO (MA PROFESSIONAL CO)
Entity type:Individual
Prefix:MS
First Name:MARY JO
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MA PROFESSIONAL CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 12TH PLACE STE 13
Mailing Address - Street 2:RECOVERY IN THE PINES
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-227-2967
Mailing Address - Fax:928-227-2968
Practice Address - Street 1:919 12TH PLACE STE 13
Practice Address - Street 2:RECOVERY IN THE PINES
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-227-2967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)