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General NPI Number Information
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NPI Number | 1114599412
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Entity Type | Individual
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Provider Name | LUCAS CHARLES FISCHER MED
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Gender | Male
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 06/21/2024
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Provider Practice Location Address
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Address Line | 100 E NORMAL AVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4200
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Country | US
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Telephone | 660-785-4014
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Fax | 660-785-4011
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Provider Business Mailing Address
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Address Line | 100 E NORMAL AVE
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City | KIRKSVILLE
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State | MO
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Zip | 63501-4200
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Country | US
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Telephone | 660-785-4182
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Fax | 660-785-4182
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2021035034
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License Number State | MO
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