1528099249 NPI number — BETSY LOUISE FISHER LMFT

Table of content: BETSY LOUISE FISHER LMFT (NPI 1528099249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528099249 NPI number — BETSY LOUISE FISHER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
BETSY
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VEDDER
Provider Other First Name:
BETSY
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528099249
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 AUSTIN BLUFFS PKWY
Provider Second Line Business Mailing Address:
PULPIT ROCK CHURCH
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80918-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-535-0969
Provider Business Mailing Address Fax Number:
719-598-1168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 AUSTIN BLUFFS PKWY
Provider Second Line Business Practice Location Address:
PULPIT ROCK CHURCH
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80918-3922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-535-0969
Provider Business Practice Location Address Fax Number:
719-598-1168
Provider Enumeration Date:
07/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  CO 240 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)