Healthcare Provider Details

I. General information

NPI: 1740645720
Provider Name (Legal Business Name): MARIE FISHER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2015
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WASHINGTON ST
MONTICELLO MN
55362-8815
US

IV. Provider business mailing address

407 WASHINGTON ST
MONTICELLO MN
55362-8815
US

V. Phone/Fax

Practice location:
  • Phone: 763-295-4001
  • Fax: 763-295-5086
Mailing address:
  • Phone: 763-295-4001
  • Fax: 763-295-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00609
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: