MEDICARE: BRYAN FIELDS

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor		AK
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1265086078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN FIELDS

Provider Business Mailing Address
First Line	:	300 N WILLOW ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7042
Country	:	US
Telephone Number	:	907-313-1333
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 N WILLOW ST
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7042
Country	:	US
Telephone Number	:	907-357-8780
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2019
Last Update Date	:	04/16/2026

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Directions to “ BRYAN FIELDS ” Practice Location

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