Basic Information
| Provider Information | |||||||||
| NPI: | 1003801762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | EMILY | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 SE DEWEY | ||||||||
| Address2: | STE 301 | ||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183367090 | ||||||||
| FaxNumber: | 9183368090 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 SE DEWEY | ||||||||
| Address2: | STE 301 | ||||||||
| City: | BARTLESVILLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183367090 | ||||||||
| FaxNumber: | 9183368090 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 748 | OK | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.