Provider Demographics
NPI:1063537413
Name:FISHER, CHARLES ROSS (PHD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROSS
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 SO DATURA CT
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2161
Mailing Address - Country:US
Mailing Address - Phone:303-798-3690
Mailing Address - Fax:303-798-3690
Practice Address - Street 1:4770 E ILIFF
Practice Address - Street 2:SUITE 111
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-918-0658
Practice Address - Fax:303-798-3690
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical