MEDICARE: AUBRI MICHELLE FISHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194323840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBRI MICHELLE FISHER

Provider Business Mailing Address
First Line	:	851 COMMERCE BLVD STE 107
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18519-1762
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 COMMERCE BLVD STE 107
Second Line	:
City	:	SCRANTON
State	:	PA
Zip	:	18519-1762
Country	:	US
Telephone Number	:	570-489-5561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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