Provider Demographics
NPI:1386151041
Name:FIELDS, MARK WILLIAM (QMHP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:FIELDS
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 SE 82ND AVE STE O
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7641
Mailing Address - Country:US
Mailing Address - Phone:503-722-6200
Mailing Address - Fax:503-722-6545
Practice Address - Street 1:11211 SE 82ND AVE STE O
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-7641
Practice Address - Country:US
Practice Address - Phone:503-722-6200
Practice Address - Fax:503-722-6545
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor