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General NPI Number Information
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NPI Number | 1174378541
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Entity Type | Organization
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Legal Business Name | FISHER'S PLAYHOUSE
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2220 BOXWOOD CIR
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City | PORTALES
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State | NM
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Zip | 88130-9356
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Country | US
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Telephone | 850-972-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 BOXWOOD CIR
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City | PORTALES
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State | NM
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Zip | 88130-9356
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Country | US
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Telephone | 850-972-8193
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEMPSEY FISHER
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Credential | LCSW
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Telephone | 850-972-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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