Provider Demographics
NPI:1740381821
Name:FIELD, GARY DONALD (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DONALD
Last Name:FIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 COMMERCIAL ST SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302
Mailing Address - Country:US
Mailing Address - Phone:503-508-7402
Mailing Address - Fax:503-588-5921
Practice Address - Street 1:2659 COMMERCIAL ST SE
Practice Address - Street 2:SUITE 220
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-508-7402
Practice Address - Fax:503-588-5921
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical