1043406309 NPI number — MS. JACQUELINE PATRICIA LOUISE FISHER LMFT

Table of content: MS. JACQUELINE PATRICIA LOUISE FISHER LMFT (NPI 1043406309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043406309 NPI number — MS. JACQUELINE PATRICIA LOUISE FISHER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
JACQUELINE
Provider Middle Name:
PATRICIA LOUISE
Provider Name Prefix Text:
MS.
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043406309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 E TAHQUITZ CANYON WAY STE 117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-320-3838
Provider Business Mailing Address Fax Number:
760-320-3733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 E HOBSONWAY STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLYTHE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92225-1778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-320-3838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2007

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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