Provider Demographics
NPI:1063809341
Name:FISHER, DESIREE MONIQUE (LPC)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:MONIQUE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:DESIREE
Other - Middle Name:MONIQUE
Other - Last Name:EMBRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13375 E 32ND PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-4044
Mailing Address - Country:US
Mailing Address - Phone:918-406-4789
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4029
Practice Address - Country:US
Practice Address - Phone:918-561-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-24
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6762101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional