Provider Demographics
NPI:1932302247
Name:FISHER, JIM ELLIS (LCSW, PIP, EAP)
Entity Type:Individual
Prefix:MS
First Name:JIM
Middle Name:ELLIS
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW, PIP, EAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E 13TH ST STE 227
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-4602
Mailing Address - Country:US
Mailing Address - Phone:256-237-4990
Mailing Address - Fax:256-237-9205
Practice Address - Street 1:7 E 13TH ST STE 227
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-4602
Practice Address - Country:US
Practice Address - Phone:256-237-4990
Practice Address - Fax:256-237-9205
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor