=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336577998
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARTH FISCHER LCPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2013
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 N 99TH ST
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66109
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-712-9257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17600 157TH ST
-----------------------------------------------------
City | BASEHOR
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66007-7377
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-308-6678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2796
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------