MEDICARE: GEORGE ANDREW FISH MA, CMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	6999349-6004	UT

General Provider Information

NPI Number	:	1083975718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE ANDREW FISH MA, CMHC

Provider Business Mailing Address
First Line	:	7070 S UNION PARK AVE STE 150
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-6043
Country	:	US
Telephone Number	:	801-528-7309
Fax Number	:	385-446-2650

Provider Business Practice Location Address
First Line	:	7070 S UNION PARK AVE STE 150
Second Line	:
City	:	MIDVALE
State	:	UT
Zip	:	84047-6043
Country	:	US
Telephone Number	:	801-528-7309
Fax Number	:	385-446-2650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2012
Last Update Date	:	07/05/2024

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