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General NPI Number Information
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NPI Number | 1366686735
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Entity Type | Individual
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Provider Name | LAVERN M FISHER M.A.
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Gender | Female
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Dates
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Enumeration Date | 04/28/2009
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Last Update Date | 04/07/2010
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Provider Practice Location Address
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Address Line | 803 VANDERCOOK WAY STE 9
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City | LONGVIEW
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State | WA
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Zip | 98632-4039
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Country | US
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Telephone | 360-431-9987
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Fax | 360-539-0010
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Provider Business Mailing Address
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Address Line | PO BOX 1400
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City | KALAMA
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State | WA
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Zip | 98625-1200
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Country | US
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Telephone | 360-431-9987
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Fax |
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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 | RC00043956
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60110623
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License Number State | WA
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