Healthcare Provider Details

I. General information

NPI: 1134465552
Provider Name (Legal Business Name): MALLORY ELIZABETH FISHER M.A. LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 HEWITT AVE SUITE 518
EVERETT WA
98201-3570
US

IV. Provider business mailing address

17716 BOTHELL EVERETT HWY E102
BOTHELL WA
98012-6351
US

V. Phone/Fax

Practice location:
  • Phone: 425-202-5242
  • Fax:
Mailing address:
  • Phone: 425-202-5242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMC60302183
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60302183
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60561535
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: