Provider Demographics
NPI:1871937912
Name:BURRELL FLEMING, AUGELICA ANDREA
Entity type:Individual
Prefix:MRS
First Name:AUGELICA
Middle Name:ANDREA
Last Name:BURRELL FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AUGELICA
Other - Middle Name:ANDREA
Other - Last Name:BURRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5714 NW LADY MARNA AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-2000
Mailing Address - Country:US
Mailing Address - Phone:580-647-6083
Mailing Address - Fax:
Practice Address - Street 1:5714 NW LADY MARNA AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-2000
Practice Address - Country:US
Practice Address - Phone:580-647-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst