Provider Demographics
NPI:1447690045
Name:FISCHBACK, LIAM
Entity type:Individual
Prefix:
First Name:LIAM
Middle Name:
Last Name:FISCHBACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 E 400 S
Mailing Address - Street 2:2
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-2052
Mailing Address - Country:US
Mailing Address - Phone:801-491-3065
Mailing Address - Fax:801-491-8604
Practice Address - Street 1:330 E 400 S
Practice Address - Street 2:2
Practice Address - City:SPRINGVILLE
Practice Address - State:UT
Practice Address - Zip Code:84663-2052
Practice Address - Country:US
Practice Address - Phone:801-491-3065
Practice Address - Fax:801-491-8604
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor