Individual
BRENT L. FLETCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1312 E LARK ST, SPRINGFIELD, MO 65804-7351
(417) 820-3707
(417) 820-7954
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2000151679
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
495079204
—
MO
01
—
83790
AR BLUE SHIELD #
MO
Enumeration date
02/16/2007
Last updated
07/22/2008
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