Healthcare Provider Details

I. General information

NPI: 1629229828
Provider Name (Legal Business Name): SHERRY J FISHER MA COUN PSYCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PIIMAUNA ST
MAKAWAO HI
96768-8869
US

IV. Provider business mailing address

135 PIIMAUNA ST
MAKAWAO HI
96768-8869
US

V. Phone/Fax

Practice location:
  • Phone: 808-205-2482
  • Fax:
Mailing address:
  • Phone: 808-205-2482
  • Fax:

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 Code305S00000X
TaxonomyPoint of Service
License NumberMHC-350
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: