Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LPC.0015143 | CO |
NPI | 1003344094 |
---|---|
Provider Name | Mac Aarron Fish |
First Address | Grand Junction, CO 81505-2303 |
Second Address | Grand Junction, CO 81505-2303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2017 |
Last Update Date | 27/01/2021 |