Healthcare Provider Details

I. General information

NPI: 1710417639
Provider Name (Legal Business Name): LAURA CHRISTINE FISCHER MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

5210 VIA DEL VALLE
SANTA FE NM
87507-5173
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-5006
  • Fax: 505-820-9220
Mailing address:
  • Phone: 763-234-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0206991
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: