Provider Demographics
NPI:1073873998
Name:HALL-FISHER, SAMANTHA GLEN (MS)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:GLEN
Last Name:HALL-FISHER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W LINCOLN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3850
Mailing Address - Country:US
Mailing Address - Phone:765-614-1217
Mailing Address - Fax:
Practice Address - Street 1:315 W LINCOLN RD
Practice Address - Street 2:SUITE B
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3850
Practice Address - Country:US
Practice Address - Phone:765-614-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor