Provider Demographics
NPI:1184700718
Name:FISTER, JAMIE (BA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:FISTER
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21372 BROOKHURST ST UNIT 627
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-7315
Mailing Address - Country:US
Mailing Address - Phone:619-757-6793
Mailing Address - Fax:
Practice Address - Street 1:1901 E CENTER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-3457
Practice Address - Country:US
Practice Address - Phone:714-780-0750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health