Provider Demographics
NPI:1962743328
Name:FIELDS, TAMARA (LCSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:HOLLOWAY-LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:5401 RED PINE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5784
Mailing Address - Country:US
Mailing Address - Phone:708-275-0937
Mailing Address - Fax:
Practice Address - Street 1:1705 S FORT HOOD ST
Practice Address - Street 2:UNIT 103
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1680
Practice Address - Country:US
Practice Address - Phone:708-275-0937
Practice Address - Fax:708-310-6057
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0143851041C0700X
TX585691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical