Provider Demographics
NPI:1710119680
Name:FIELDS FAMILY COUNSELING SERVICES, INC.
Entity Type:Organization
Organization Name:FIELDS FAMILY COUNSELING SERVICES, INC.
Other - Org Name:FIELDS FAMILY SERVICES, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAKEYA
Authorized Official - Middle Name:TONISHA
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PPS
Authorized Official - Phone:800-488-3414
Mailing Address - Street 1:530 S LAKE AVE STE 236
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3515
Mailing Address - Country:US
Mailing Address - Phone:800-488-3414
Mailing Address - Fax:866-488-8170
Practice Address - Street 1:547 S MARENGO AVE STE 203
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3114
Practice Address - Country:US
Practice Address - Phone:800-488-3414
Practice Address - Fax:866-488-8170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty