Provider Demographics
NPI:1275193286
Name:FISHER, CHLOE ELLA (QMHA)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:ELLA
Last Name:FISHER
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1548
Mailing Address - Country:US
Mailing Address - Phone:503-252-3304
Mailing Address - Fax:
Practice Address - Street 1:7405 SE 84TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-5840
Practice Address - Country:US
Practice Address - Phone:503-238-0796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health