Provider Demographics
NPI:1740497692
Name:FISHER, KATHY LYNN (MFT)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 695
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425-0695
Mailing Address - Country:US
Mailing Address - Phone:707-595-3526
Mailing Address - Fax:
Practice Address - Street 1:555 5TH ST
Practice Address - Street 2:SUITE 300R
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-6342
Practice Address - Country:US
Practice Address - Phone:707-595-3526
Practice Address - Fax:707-541-6746
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist