Provider Demographics
NPI:1992475099
Name:FISHER, AMELIA (LPC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
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 1:7601 CHURCHILL WAY APT 1732
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-1946
Mailing Address - Country:US
Mailing Address - Phone:314-660-2891
Mailing Address - Fax:
Practice Address - Street 1:14651 DALLAS PKWY STE 134
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-8904
Practice Address - Country:US
Practice Address - Phone:314-660-2891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty