Provider Demographics
NPI:1457612970
Name:FISHER, KELLY T
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:T
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 TROJAN WAY
Mailing Address - Street 2:216 TROJAN WAY
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-0125
Mailing Address - Country:US
Mailing Address - Phone:702-576-2758
Mailing Address - Fax:
Practice Address - Street 1:216 TROJAN WAY
Practice Address - Street 2:216 TROJAN WAY
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-0125
Practice Address - Country:US
Practice Address - Phone:702-576-2758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2025-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98086101YM0800X
NVCP5035101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health