Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 35001493A | IN |
N | 1041C0700X | Clinical Social Worker | 35001493A | IN |
NPI | 1336106434 |
---|---|
Provider Name | Timothy E Fisher |
First Address | Indianapolis, IN 46250-2040 |
Second Address | Anderson, IN 46012-4350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 08/07/2007 |