Provider Demographics
NPI:1174032692
Name:FISH, ERICA (CMHC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 E EXCHANGE PL STE 130
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2713
Mailing Address - Country:US
Mailing Address - Phone:801-637-5078
Mailing Address - Fax:
Practice Address - Street 1:66 E EXCHANGE PL STE 130
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2713
Practice Address - Country:US
Practice Address - Phone:801-637-5078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6242363-6004101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor