Healthcare Provider Details

I. General information

NPI: 1093491474
Provider Name (Legal Business Name): MRS. LUCRESIA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. LUCRESIA BLANKENSHIP

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14B 4TH ST E # 588B
UNIVERSAL CITY TX
78148-5744
US

IV. Provider business mailing address

14B 4TH ST E # 588B
UNIVERSAL CITY TX
78148-5744
US

V. Phone/Fax

Practice location:
  • Phone: 325-271-8477
  • Fax:
Mailing address:
  • Phone: 325-271-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number95907
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: