Provider Demographics
NPI:1689313199
Name:FIELDS, FELICIA R (BEHAVIOR HEALTH SPEC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:R
Last Name:FIELDS
Suffix:
Gender:F
Credentials:BEHAVIOR HEALTH SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 JENNIFER LN
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-5501
Mailing Address - Country:US
Mailing Address - Phone:817-662-7778
Mailing Address - Fax:
Practice Address - Street 1:4309 JENNIFER LN
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-5501
Practice Address - Country:US
Practice Address - Phone:214-546-5836
Practice Address - Fax:844-270-2825
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103T00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528648854OtherBEHAVIOR HEALTH SPECIALIST