Doctor Name: | DR. GLEN STUART FISHER |
NPI Number: | 1023068707 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 958 |
Business Practice Address: | 2504 S Chicago St Fairchild Afb, WA - 990118548 |
Business Phone Number: | 5092478938 |
Business Fax Number: | |
Mailing Address: | 701 Hospital Loop, Fairchild Afb FAIRCHILD AIR FORCE BASE |
State: | WA |
Postal Code: | 990118704 |
Phone Number: | 5092478938 |
Fax Number: | |
NPI Enumeration Date: | 05/11/2006 |
NPI Last Update Date: | 07/12/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 958 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |