Basic Information
| Provider Information | |||||||||
| NPI: | 1316601370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | BRIN | ||||||||
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| Credential: | CMHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 S 4TH ST STE 401 | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582014715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017953000 | ||||||||
| FaxNumber: | 7017953050 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 S 4TH ST STE 401 | ||||||||
| Address2: | |||||||||
| City: | GRAND FORKS | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582014715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017953084 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2021 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | 10627 | ND | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.