Provider Demographics
NPI:1497371850
Name:FIELDS FERRIS, JENNIFER AMY (LMFT , ATR)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:AMY
Last Name:FIELDS FERRIS
Suffix:
Gender:F
Credentials:LMFT , ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 AVIATION BLVD UNIT B
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-2334
Mailing Address - Country:US
Mailing Address - Phone:312-934-6142
Mailing Address - Fax:
Practice Address - Street 1:2406 AVIATION BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-2334
Practice Address - Country:US
Practice Address - Phone:312-934-6142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43864OtherBOARD OF BEHAVIORAL SCIENCES LMFT
CA04002OtherART THERAPY CREDENTIALS BOARD