Healthcare Provider Details

I. General information

NPI: 1669801635
Provider Name (Legal Business Name): STEPHANIE FISHER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2013
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W PERSHING BLVD
CHEYENNE WY
82001-2537
US

IV. Provider business mailing address

821 W PERSHING BLVD
CHEYENNE WY
82001-2537
US

V. Phone/Fax

Practice location:
  • Phone: 307-638-4625
  • Fax:
Mailing address:
  • Phone: 307-638-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPPC-786
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1646
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: