Provider Demographics
NPI:1245749415
Name:FISHER, PHYLLICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PHYLLICIA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 DULLES AVE APT 1128
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5746
Mailing Address - Country:US
Mailing Address - Phone:678-687-8172
Mailing Address - Fax:
Practice Address - Street 1:1025 DULLES AVE APT 1128
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5746
Practice Address - Country:US
Practice Address - Phone:678-687-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA145171041C0700X
TX596901041C0700X
NV11062-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical