Provider Demographics
NPI:1053624064
Name:FIELDS, ADAM (LMFT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:24300 CHAGRIN BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5629
Mailing Address - Country:US
Mailing Address - Phone:310-614-2202
Mailing Address - Fax:
Practice Address - Street 1:24300 CHAGRIN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5629
Practice Address - Country:US
Practice Address - Phone:310-614-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52984106H00000X
OHF.2200266-SUPV106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7068Medicaid
CA7420Medicaid