MEDICARE: KATIE MARIE 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	101YM0800X	Mental Health Counselor	LPC.0021761	CO
2	101YM0800X	Mental Health Counselor	21061	NC
3	101YM0800X	Mental Health Counselor	MH13586	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT3569	OTHER	FL	STATE LICENSURE
2	MH13586	OTHER	FL	STATE LICENSURE

General Provider Information

NPI Number	:	1962729822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MARIE FIELDS

Provider Business Mailing Address
First Line	:	4300 SW 13TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-4006
Country	:	US
Telephone Number	:	352-374-5600
Fax Number	:	352-374-5608

Provider Business Practice Location Address
First Line	:	2830 NW 41ST ST STE E
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6667
Country	:	US
Telephone Number	:	352-262-9788
Fax Number	:

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

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	02/05/2025

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Directions to “ KATIE MARIE FIELDS ” Practice Location

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