Provider Demographics
NPI:1811249832
Name:FIELDS, KRISTIN N (LPCC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:N
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:N
Other - Last Name:IGNATIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:13201 GRANGER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1979
Mailing Address - Country:US
Mailing Address - Phone:216-831-2255
Mailing Address - Fax:216-378-3906
Practice Address - Street 1:13201 GRANGER RD STE 8
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-1979
Practice Address - Country:US
Practice Address - Phone:216-831-2255
Practice Address - Fax:216-378-3906
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900178101YM0800X
OHE.0900178101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871101Medicaid