Provider Demographics
NPI:1972250181
Name:FISH, KIYOSHI (MA)
Entity Type:Individual
Prefix:
First Name:KIYOSHI
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13571 W REMUDA DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-8305
Mailing Address - Country:US
Mailing Address - Phone:602-577-6352
Mailing Address - Fax:
Practice Address - Street 1:13571 W REMUDA DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-8305
Practice Address - Country:US
Practice Address - Phone:602-577-6352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician