Provider Demographics
NPI:1801061122
Name:FISHER, LYNDA MAE (MC, LISAC, LPC)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:MAE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MC, LISAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W LAGUNA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-4812
Mailing Address - Country:US
Mailing Address - Phone:480-491-0203
Mailing Address - Fax:
Practice Address - Street 1:2266 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6488
Practice Address - Country:US
Practice Address - Phone:480-491-0203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC1123101Y00000X
AZLISAC0572101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)