Provider Demographics
NPI:1295232403
Name:FISHER, JONATHAN (LPC)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 NATCHEZ AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7644
Mailing Address - Country:US
Mailing Address - Phone:832-262-2351
Mailing Address - Fax:
Practice Address - Street 1:923 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5526
Practice Address - Country:US
Practice Address - Phone:817-778-9071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional