Provider Demographics
NPI:1518116748
Name:FISHER, ANDREW M (LCPC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:FISHER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HERITAGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2516
Mailing Address - Country:US
Mailing Address - Phone:815-214-4713
Mailing Address - Fax:
Practice Address - Street 1:14 HERITAGE DR STE 101
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2516
Practice Address - Country:US
Practice Address - Phone:815-214-4713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional