Active NPI
Andre Rubin Fields, TLLP
- Counseling Psychologist
- Portage, MI
National Provider Identifier
1407022874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 6301013802
- Practice address
- 8175 Creekside Dr
Suite 264
Portage, MI 49024-5377 - Phone
- (269) 321-5033
- NPI assigned
- May 5, 2008
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 6301013802 | MI | Primary |
Addresses
Primary practice location
8175 Creekside Dr
Suite 264
Portage, MI 49024-5377
Mailing address
1336 Rosewood Ave SE
Grand Rapids, MI 49506-3931
Phone (616) 734-9779
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 |
|---|---|---|---|
| 6301013802 | MI | MD | Counseling Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209945600000",
"number": "1407022874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1336 ROSEWOOD AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495063931",
"telephone_number": "616-734-9779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8175 CREEKSIDE DR",
"address_2": "SUITE 264",
"city": "PORTAGE",
"state": "MI",
"postal_code": "490245377",
"telephone_number": "269-321-5033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIELDS",
"first_name": "ANDRE",
"middle_name": "RUBIN",
"name_prefix": "Mr.",
"credential": "TLLP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-05",
"last_updated": "2008-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "MI",
"license": "6301013802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portage, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.