Provider Demographics
NPI:1417495391
Name:FISHER, LESLIE A (RYT, LCMHC, LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:RYT, LCMHC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 COURT ST
Mailing Address - Street 2:
Mailing Address - City:LACONIA
Mailing Address - State:NH
Mailing Address - Zip Code:03246-3636
Mailing Address - Country:US
Mailing Address - Phone:603-387-4896
Mailing Address - Fax:603-527-8362
Practice Address - Street 1:109 COURT ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3636
Practice Address - Country:US
Practice Address - Phone:603-260-1101
Practice Address - Fax:603-527-8362
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00858101YM0800X
MA10391101YM0800X
NH1238101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699245613OtherNPPES