Provider Demographics
NPI:1063581494
Name:FIELDS HARRIS, MORINE R (LCPC)
Entity type:Individual
Prefix:MS
First Name:MORINE
Middle Name:R
Last Name:FIELDS HARRIS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3692 PERUGIA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3499
Mailing Address - Country:US
Mailing Address - Phone:773-539-5993
Mailing Address - Fax:
Practice Address - Street 1:7455 ARROYO CROSSING PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4085
Practice Address - Country:US
Practice Address - Phone:773-307-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005395101YP2500X
NVCP0111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001634828OtherBLUECROSS BLUE SHIELD