Provider Demographics
NPI:1073756664
Name:FISHER, TAMMY (LPC-I, LMFT-A)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPC-I, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1356
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-1356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 BAILEY LOOP
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-4640
Practice Address - Country:US
Practice Address - Phone:512-940-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-12
Last Update Date:2009-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63345101Y00000X
TX201262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist