Provider Demographics
NPI:1184119521
Name:FLEMING, ELIZABETH MARIE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:ST PAUL PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55071-1218
Mailing Address - Country:US
Mailing Address - Phone:651-343-4364
Mailing Address - Fax:
Practice Address - Street 1:7582 CURRELL BLVD STE 108
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8210
Practice Address - Country:US
Practice Address - Phone:651-739-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health