Provider Demographics
NPI:1295908945
Name:FISHER, MICHAEL F (MS, LADC/MH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:FISHER
Suffix:
Gender:M
Credentials:MS, LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27371 S 4410 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-7953
Mailing Address - Country:US
Mailing Address - Phone:918-256-4800
Mailing Address - Fax:918-256-4588
Practice Address - Street 1:27371 S 4410 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-7953
Practice Address - Country:US
Practice Address - Phone:918-256-4800
Practice Address - Fax:918-256-4588
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK176101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100257840AMedicaid
OK244402801OtherMEDICARE ID-TYPE UNSPECFIED
OK244402801OtherMEDICARE ID-TYPE UNSPECFIED