MEDICARE: MS. DALE J FISHER LMHC

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	LH00006438	WA

General Provider Information

NPI Number	:	1942200217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DALE J FISHER LMHC

Provider Business Mailing Address
First Line	:	401 OLYMPIA AVE NE UNIT 26
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-4119
Country	:	US
Telephone Number	:	425-255-4331
Fax Number	:	425-255-3310

Provider Business Practice Location Address
First Line	:	401 OLYMPIA AVE NE UNIT 26
Second Line	:
City	:	RENTON
State	:	WA
Zip	:	98056-4119
Country	:	US
Telephone Number	:	425-255-4331
Fax Number	:	425-255-3311

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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