Provider Demographics
NPI:1629268131
Name:DEBORRA FIELDS M.S. LPC.
Entity Type:Organization
Organization Name:DEBORRA FIELDS M.S. LPC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORRA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:907-243-5130
Mailing Address - Street 1:2825 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2830
Mailing Address - Country:US
Mailing Address - Phone:907-243-5130
Mailing Address - Fax:907-248-8350
Practice Address - Street 1:2825 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2830
Practice Address - Country:US
Practice Address - Phone:907-243-5130
Practice Address - Fax:907-248-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK276171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM 11151Medicaid
AKCMG 1111Medicaid