Provider Demographics
NPI:1609221803
Name:FIELDS, TARA ANN (MSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:FIELDS
Suffix:
Gender:F
Credentials:MSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGELAND DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-3021
Mailing Address - Country:US
Mailing Address - Phone:785-210-7707
Mailing Address - Fax:
Practice Address - Street 1:1412 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ATCHISON
Practice Address - State:KS
Practice Address - Zip Code:66002-1203
Practice Address - Country:US
Practice Address - Phone:913-367-4879
Practice Address - Fax:913-367-0240
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS111641041C0700X, 1041C0700X
KS49161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical