Healthcare Provider Details

I. General information

NPI: 1902581697
Provider Name (Legal Business Name): LAURA FISCHER CREATIVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 LUJAN ST
SANTA FE NM
87505-3218
US

IV. Provider business mailing address

1202 LUJAN ST
SANTA FE NM
87505-3218
US

V. Phone/Fax

Practice location:
  • Phone: 763-234-8720
  • Fax:
Mailing address:
  • Phone: 763-234-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LAURA CHRISTINE FISCHER
Title or Position: THERAPIST, BUSINESS OWNER
Credential: LPCC
Phone: 763-234-8720