=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033534920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR ANDREW J FIELDS PHD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2014
-----------------------------------------------------
Last Update Date | 02/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7120 E ORCHARD RD STE 450
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-334-7169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7120 E ORCHARD RD STE 450
-----------------------------------------------------
City | CENTENNIAL
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80111-1771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-334-7169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. ANDREW J FIELDS
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 720-334-7169
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 3684
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------