Provider Demographics
NPI:1639707730
Name:FISHER, DEANA LYNN (LCPC)
Entity type:Individual
Prefix:MISS
First Name:DEANA
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 W 119TH ST STE 1030
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-3081
Mailing Address - Country:US
Mailing Address - Phone:773-680-4011
Mailing Address - Fax:
Practice Address - Street 1:8102 W 119TH ST STE 1030
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-3081
Practice Address - Country:US
Practice Address - Phone:708-381-0768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012872101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty