Provider Demographics
NPI:1851924567
Name:FIELDS, ELLEN FRANCINE
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:FRANCINE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 EAGLE STICKS DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2538
Mailing Address - Country:US
Mailing Address - Phone:888-222-0720
Mailing Address - Fax:
Practice Address - Street 1:2169 EAGLE STICKS DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2538
Practice Address - Country:US
Practice Address - Phone:888-222-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17931101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty