Provider Demographics
NPI:1518120229
Name:FISHER, PAUL FREDERICK (LMFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDERICK
Last Name:FISHER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 CALLE LA MIRADA
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2403
Mailing Address - Country:US
Mailing Address - Phone:619-267-5270
Mailing Address - Fax:
Practice Address - Street 1:2075 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1108
Practice Address - Country:US
Practice Address - Phone:619-590-2145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT #23779101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor