1689313199 NPI number — FELICIA R FIELDS BEHAVIOR HEALTH SPEC

Table of content: FELICIA R FIELDS BEHAVIOR HEALTH SPEC (NPI 1689313199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689313199 NPI number — FELICIA R FIELDS BEHAVIOR HEALTH SPEC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIELDS
Provider First Name:
FELICIA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BEHAVIOR HEALTH SPEC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689313199
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4309 JENNIFER LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76036-5501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-662-7778
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4309 JENNIFER LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWLEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76036-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-546-5836
Provider Business Practice Location Address Fax Number:
844-270-2825
Provider Enumeration Date:
06/02/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106S00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1528648854 . This is a "BEHAVIOR HEALTH SPECIALIST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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