Provider Demographics
NPI:1437437878
Name:FIELDS, LARRY MARTIMUS
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:MARTIMUS
Last Name:FIELDS
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 1:777 N AIR DEPOT BLVD APT 3103
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3777
Mailing Address - Country:US
Mailing Address - Phone:405-537-5563
Mailing Address - Fax:
Practice Address - Street 1:777 N AIR DEPOT BLVD APT 3103
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3777
Practice Address - Country:US
Practice Address - Phone:405-537-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst