Basic Information
| Provider Information | |||||||||
| NPI: | 1790338010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | CAMILLE | ||||||||
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| Credential: | CGC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6204 BALCONES DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124279431 | ||||||||
| FaxNumber: | 5123422723 | ||||||||
| Practice Location | |||||||||
| Address1: | 6204 BALCONES DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787314214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124279431 | ||||||||
| FaxNumber: | 5123422723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2019 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Genetic Counselor, MS |
No ID Information.