Healthcare Provider Details

I. General information

NPI: 1104345321
Provider Name (Legal Business Name): LEE M FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9622 HIGHLAND VIEW DR
DALLAS TX
75238-1028
US

IV. Provider business mailing address

9622 HIGHLAND VIEW DR
DALLAS TX
75238-1028
US

V. Phone/Fax

Practice location:
  • Phone: 817-319-2579
  • Fax:
Mailing address:
  • Phone: 817-319-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number38480
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: