Provider Demographics
NPI:1467806869
Name:FIELDS, TASHA MARIE
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:MARIE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:MARIE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3755 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-4897
Mailing Address - Country:US
Mailing Address - Phone:702-487-5665
Mailing Address - Fax:702-463-5684
Practice Address - Street 1:3755 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-4897
Practice Address - Country:US
Practice Address - Phone:702-487-5665
Practice Address - Fax:702-463-5684
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health