Healthcare Provider Details

I. General information

NPI: 1992051031
Provider Name (Legal Business Name): MR. JODY HUGHES FISCHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CAMPUS DR
YREKA CA
96097-9538
US

IV. Provider business mailing address

2060 CAMPUS DR
YREKA CA
96097-9538
US

V. Phone/Fax

Practice location:
  • Phone: 530-918-7200
  • Fax: 530-918-7216
Mailing address:
  • Phone: 530-918-7200
  • Fax: 530-918-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: