Provider Demographics
NPI:1235487471
Name:FISHER, RACHEL ELIZABETH (TLLP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:MITNICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7340 BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2821
Mailing Address - Country:US
Mailing Address - Phone:248-798-5339
Mailing Address - Fax:
Practice Address - Street 1:22170 W 9 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-6007
Practice Address - Country:US
Practice Address - Phone:248-798-5339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2245415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical