Provider Demographics
NPI:1245931203
Name:FISHER, KATHERINE HOLLIE (LPC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HOLLIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:HOLLIE
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2035 ZACH BLVD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-3815
Mailing Address - Country:US
Mailing Address - Phone:208-286-5950
Mailing Address - Fax:
Practice Address - Street 1:2035 ZACH BLVD
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-3815
Practice Address - Country:US
Practice Address - Phone:208-286-5950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional