Healthcare Provider Details

I. General information

NPI: 1184528705
Provider Name (Legal Business Name): LAUREL FIDDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 GRANDVIEW DR
BISHOP CA
93514-2984
US

IV. Provider business mailing address

89 PINON DR
CROWLEY LAKE CA
93546-9719
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-3262
  • Fax:
Mailing address:
  • Phone: 760-914-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: