Provider Demographics
NPI:1871817494
Name:FISHER, AMY KILLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KILLEN
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALL AMERICAN DRIVE
Mailing Address - Street 2:UNIVERSITY COUNSELING CENTER
Mailing Address - City:UNIVERSITY
Mailing Address - State:MS
Mailing Address - Zip Code:38677-1848
Mailing Address - Country:US
Mailing Address - Phone:662-915-3784
Mailing Address - Fax:662-915-7831
Practice Address - Street 1:ALL AMERICAN DRIVE
Practice Address - Street 2:UNIVERSITY COUNSELING CENTER
Practice Address - City:UNIVERSITY
Practice Address - State:MS
Practice Address - Zip Code:38677-1848
Practice Address - Country:US
Practice Address - Phone:662-915-3784
Practice Address - Fax:662-915-7831
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical