Active NPI
Edward Fields IV, LLPC
- Professional Counselor
- Clinton Township, MI
National Provider Identifier
1396216057
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 6401016526
- Practice address
- 36975 Utica Rd
Clinton Township, MI 48036-1685 - Phone
- (586) 596-2605
- NPI assigned
- Dec 6, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 6401016526 | MI | Primary |
Addresses
Primary practice location
36975 Utica Rd
Clinton Township, MI 48036-1685
Mailing address
36975 Utica Rd Ste 104
Clinton Township, MI 48036-1685
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401016526 | MI | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1544054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1544054400000",
"number": "1396216057",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36975 UTICA RD STE 104",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480361685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36975 UTICA RD",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480361685",
"telephone_number": "586-596-2605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIELDS",
"first_name": "EDWARD",
"name_prefix": "Mr.",
"name_suffix": "IV",
"credential": "LLPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-06",
"last_updated": "2018-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MI",
"license": "6401016526",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "05",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.