Healthcare Provider Details

I. General information

NPI: 1841774452
Provider Name (Legal Business Name): STEVEN H FISCHER CDP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12850 LALA COVE LN SE
OLALLA WA
98359-9664
US

IV. Provider business mailing address

12850 LALA COVE LN SE
OLALLA WA
98359-9664
US

V. Phone/Fax

Practice location:
  • Phone: 253-857-6201
  • Fax: 253-857-3993
Mailing address:
  • Phone: 253-857-6201
  • Fax: 253-857-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP60213201
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: