Provider Demographics
NPI:1205585049
Name:FISHER, MICHAELA RAINE (M ED LPCA)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:RAINE
Last Name:FISHER
Suffix:
Gender:F
Credentials:M ED LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-8558
Mailing Address - Country:US
Mailing Address - Phone:606-359-5017
Mailing Address - Fax:
Practice Address - Street 1:485 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-8558
Practice Address - Country:US
Practice Address - Phone:606-359-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY276617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional