Basic Information
Provider Information
NPI: 1457770323
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FISHER
FirstName: ELIZABETH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8931 HURON ST
Address2:  
City: THORNTON
State: CO
PostalCode: 802606806
CountryCode: US
TelephoneNumber: 3038533500
FaxNumber:  
Practice Location
Address1: 8931 HURON ST
Address2:  
City: THORNTON
State: CO
PostalCode: 802606806
CountryCode: US
TelephoneNumber: 3038533500
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2014
LastUpdateDate: 09/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000XLPC.0011801CON Behavioral Health & Social Service ProvidersCounselor 
101YM0800XLPC.0011801CON Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500XLPC.0011801COY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


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