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General NPI Number Information
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NPI Number | 1598007148
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Entity Type | Individual
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Provider Name | TINAMARIE FISH LMHC, MHP, CCTP
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Gender | Female
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 2512 E EVERGREEN BLVD # 1188
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City | VANCOUVER
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State | WA
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Zip | 98661-4323
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Country | US
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Telephone | 360-773-8964
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 826
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City | RIDGEFIELD
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State | WA
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Zip | 98642-0826
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Country | US
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Telephone | 360-773-8964
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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 | C7332
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License Number State | OR
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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 | C7332
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC 60190151
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License Number State | WA
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