Provider Demographics
NPI:1629662184
Name:FISHER, DAVID (LPC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 LAMAR AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2060
Mailing Address - Country:US
Mailing Address - Phone:719-660-0355
Mailing Address - Fax:
Practice Address - Street 1:6700 W 121ST ST STE 102
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2028
Practice Address - Country:US
Practice Address - Phone:913-304-4548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03745101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional