Provider Demographics
NPI:1669944112
Name:FLEMING, SUSAN HALLER (LMFT)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HALLER
Last Name:FLEMING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 4
Mailing Address - Street 2:
Mailing Address - City:CIBOLA
Mailing Address - State:AZ
Mailing Address - Zip Code:85328-9700
Mailing Address - Country:US
Mailing Address - Phone:714-883-5452
Mailing Address - Fax:
Practice Address - Street 1:295 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1703
Practice Address - Country:US
Practice Address - Phone:714-883-5452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42133106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist