Healthcare Provider Details

I. General information

NPI: 1316175177
Provider Name (Legal Business Name): MICHELLE MARIE FISCHER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 S CAMINO DEL PUEBLO
BERNALILLO NM
87004-5927
US

IV. Provider business mailing address

7820 ENCHANTED HILLS BLVD NE SUITE 221A
RIO RANCHO NM
87144-8638
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-6548
  • Fax: 505-867-7293
Mailing address:
  • Phone: 575-644-6548
  • Fax: 505-867-7293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number008701
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: