Provider Demographics
NPI:1609064674
Name:FISHER, DEREK E (MA, PCC)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:E
Last Name:FISHER
Suffix:
Gender:M
Credentials:MA, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-0335
Mailing Address - Country:US
Mailing Address - Phone:740-397-5047
Mailing Address - Fax:
Practice Address - Street 1:17606 COSHOCTON RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9218
Practice Address - Country:US
Practice Address - Phone:740-397-0533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003702101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor