Individual
MYRA LOUISE FLEETWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 838-4030
Mailing address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 838-4030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
87001414A
IN
Other
Enumeration date
07/13/2023
Last updated
07/13/2023
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