Provider Demographics
NPI:1760898605
Name:FIELDS, JAMES GARY (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GARY
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RIVERSIDE AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2682
Mailing Address - Country:US
Mailing Address - Phone:805-610-5059
Mailing Address - Fax:805-980-4029
Practice Address - Street 1:1111 RIVERSIDE AVE STE 404
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2682
Practice Address - Country:US
Practice Address - Phone:805-610-5059
Practice Address - Fax:805-980-4029
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102544106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist