MEDICARE: PAMELA JOYCE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1912030115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JOYCE FISHER

Provider Business Mailing Address
First Line	:	715 JEWELL AVE
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95991-5432
Country	:	US
Telephone Number	:	530-790-7975
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 GARDEN HWY
Second Line	:	SUITE B
City	:	YUBA CITY
State	:	CA
Zip	:	95991-6318
Country	:	US
Telephone Number	:	530-822-7133
Fax Number	:	530-822-7213

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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