Provider Demographics
NPI:1083639785
Name:FISH, ANITA (MHR , LMFT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:MHR , LMFT
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:TORRES
Other - Last Name:FISH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHR, L M F T
Mailing Address - Street 1:3508 NW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5630
Mailing Address - Country:US
Mailing Address - Phone:405-943-1281
Mailing Address - Fax:405-943-1281
Practice Address - Street 1:3508 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5630
Practice Address - Country:US
Practice Address - Phone:405-943-1281
Practice Address - Fax:405-943-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist