Healthcare Provider Details

I. General information

NPI: 1609231067
Provider Name (Legal Business Name): FISHER COUNSELING & MEDIATION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3653 CORTEZ RD W SUITE 110C
BRADENTON FL
34210-3168
US

IV. Provider business mailing address

3653 CORTEZ RD W SUITE 110C
BRADENTON FL
34210-3168
US

V. Phone/Fax

Practice location:
  • Phone: 941-758-2529
  • Fax: 941-755-3564
Mailing address:
  • Phone: 941-758-2529
  • Fax: 941-755-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. VALERIE ANGELICA FISHER
Title or Position: OWNER
Credential: LMHC
Phone: 941-758-2529