Provider Demographics
NPI:1730811829
Name:FISHER, RENEE CHRISTINE (ACMHC)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:CHRISTINE
Last Name:FISHER
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 S 1145 W UNIT 49D
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2463
Mailing Address - Country:US
Mailing Address - Phone:801-592-5505
Mailing Address - Fax:
Practice Address - Street 1:1425 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84105-2125
Practice Address - Country:US
Practice Address - Phone:801-592-5505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12307930-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health