Provider Demographics
NPI:1487655593
Name:FISCHER, SUSAN DIANE (PSYD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 TEAGUE DR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2640
Mailing Address - Country:US
Mailing Address - Phone:903-892-4466
Mailing Address - Fax:903-892-2634
Practice Address - Street 1:1800 TEAGUE DR
Practice Address - Street 2:SUITE 502
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2640
Practice Address - Country:US
Practice Address - Phone:903-892-4466
Practice Address - Fax:903-892-2634
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25169103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1002008-01Medicaid
TX81969PMedicare ID - Type UnspecifiedMEDICARE IDENTIFIER
TX1002008-01Medicaid