Provider Demographics
NPI:1033722798
Name:FISHER, MARK EVAN (LMHCA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EVAN
Last Name:FISHER
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21703 SE 259TH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-7568
Mailing Address - Country:US
Mailing Address - Phone:206-280-8722
Mailing Address - Fax:
Practice Address - Street 1:27203 216TH AVE SE STE 5
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-3273
Practice Address - Country:US
Practice Address - Phone:253-334-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health