MEDICARE: MR. WILLIAM ANDREW FIELDS IMF 69113

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	69113	CA

General Provider Information

NPI Number	:	1700915949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM ANDREW FIELDS IMF 69113

Provider Business Mailing Address
First Line	:	3974 KENWAY AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-4806
Country	:	US
Telephone Number	:	323-299-5770
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 W AVENUE J STE C
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-3443
Country	:	US
Telephone Number	:	661-949-0131
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	05/30/2013

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