Provider Demographics
NPI:1558685131
Name:FISHER, PAMELA JANE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JANE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:HEATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 W TYLER ST STE F
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-2239
Mailing Address - Country:US
Mailing Address - Phone:903-680-0678
Mailing Address - Fax:
Practice Address - Street 1:109 W TYLER ST STE F
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-2239
Practice Address - Country:US
Practice Address - Phone:903-680-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX394111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical