Provider Demographics
NPI:1174673321
Name:FISHER, NICHOLAS S (LMFT)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:S
Last Name:FISHER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AUBURN
Mailing Address - State:IA
Mailing Address - Zip Code:52313-9635
Mailing Address - Country:US
Mailing Address - Phone:319-472-4499
Mailing Address - Fax:319-472-4499
Practice Address - Street 1:203 E 4TH ST
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-1804
Practice Address - Country:US
Practice Address - Phone:319-472-4499
Practice Address - Fax:319-472-4499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA163686000Medicaid