Provider Demographics
NPI:1609002062
Name:MATHIS-FISHER, JENNIFER PAIGE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PAIGE
Last Name:MATHIS-FISHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16581 NW 9TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1459
Mailing Address - Country:US
Mailing Address - Phone:954-319-1046
Mailing Address - Fax:954-587-7527
Practice Address - Street 1:350 NW 70TH AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2349
Practice Address - Country:US
Practice Address - Phone:954-587-7520
Practice Address - Fax:954-587-7527
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health