Provider Demographics
NPI:1427690163
Name:FISHER, AMY LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-7097
Mailing Address - Country:US
Mailing Address - Phone:479-319-6579
Mailing Address - Fax:
Practice Address - Street 1:305 S.W. 18TH STREET
Practice Address - Street 2:SUITE #7
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712
Practice Address - Country:US
Practice Address - Phone:479-319-6579
Practice Address - Fax:479-319-6570
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1906076101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health