Provider Demographics
NPI:1134465552
Name:FISHER, MALLORY ELIZABETH (MA LMHC)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ELIZABETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17716 BOTHELL EVERETT HWY
Mailing Address - Street 2:E102
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6351
Mailing Address - Country:US
Mailing Address - Phone:425-202-5242
Mailing Address - Fax:
Practice Address - Street 1:1721 HEWITT AVE
Practice Address - Street 2:SUITE 518
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3570
Practice Address - Country:US
Practice Address - Phone:425-202-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60302183101YM0800X, 101Y00000X
WALH60561535101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor