Provider Demographics
NPI:1457188104
Name:FISHER, JONATHAN RAYMOND (AMFT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAYMOND
Last Name:FISHER
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 E SIERRA MADRE BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2669
Mailing Address - Country:US
Mailing Address - Phone:909-973-0990
Mailing Address - Fax:
Practice Address - Street 1:1900 ROYALTY DR STE 180
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3046
Practice Address - Country:US
Practice Address - Phone:909-766-7340
Practice Address - Fax:909-865-0730
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist