Healthcare Provider Details

I. General information

NPI: 1912056656
Provider Name (Legal Business Name): BOB FISHER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 E SUNSHINE ST SUITE 811
SPRINGFIELD MO
65804-1343
US

IV. Provider business mailing address

5102 CHERRY PL
SPRINGFIELD MO
65809-1803
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-4485
  • Fax: 417-882-5517
Mailing address:
  • Phone: 417-818-8999
  • Fax: 417-882-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2004014922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: