Provider Demographics
NPI:1588982391
Name:FIELDS, WILLIE LEON JR (BSW)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:LEON
Last Name:FIELDS
Suffix:JR
Gender:M
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 NE 61ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1419
Mailing Address - Country:US
Mailing Address - Phone:918-899-8441
Mailing Address - Fax:
Practice Address - Street 1:507 NE 61ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-1419
Practice Address - Country:US
Practice Address - Phone:918-899-8441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS104100000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker