Provider Demographics
NPI:1952512162
Name:FISCHER, JILL ALLISON (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:ALLISON
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BOWER LN
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1327
Mailing Address - Country:US
Mailing Address - Phone:949-929-1583
Mailing Address - Fax:
Practice Address - Street 1:33161 CAMINO CAPISTRANO
Practice Address - Street 2:SUITE C
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-4826
Practice Address - Country:US
Practice Address - Phone:949-929-1583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist