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NPI Code Detail

MEDICARE: MR. DYLAN NEIL FIELDS LPC

MEDICARE:  MR. DYLAN NEIL FIELDS  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1194007229
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DYLAN NEIL FIELDS LPC
Provider Business Mailing Address
First Line : 1215 NE 63RD AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97213-4903
Country : US
Telephone Number : 971-237-3329
Fax Number :
Provider Business Practice Location Address
First Line : 12121 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97216-3737
Country : US
Telephone Number : 971-361-7760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2011
Last Update Date : 05/16/2024

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Directions to “ MR. DYLAN NEIL FIELDS LPC” Practice Location

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