MEDICARE: ROBERT NICHOLS FISHER LMFT, CART

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	106H00000X	Marriage & Family Therapist	4962	TX

General Provider Information

NPI Number	:	1922237304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT NICHOLS FISHER LMFT, CART

Provider Business Mailing Address
First Line	:	PO BOX 792231
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78279-2231
Country	:	US
Telephone Number	:	210-872-1828
Fax Number	:

Provider Business Practice Location Address
First Line	:	6315 BARTON MILL ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-4602
Country	:	US
Telephone Number	:	210-872-1828
Fax Number	:

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

Provider Enumeration Date	:	07/07/2009
Last Update Date	:	03/20/2013

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