MEDICARE: MRS. MICHELLE R FELLER LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	959	MT
2	101YP2500X	Professional Counselor	959-LCPC	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	F1081	OTHER	APS HEALTHCARE
2	744623	OTHER	BLUECROSS/BLUESHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861494452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE R FELLER LCPC

Provider Business Mailing Address
First Line	:	1720 DINO COURT
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-5703
Country	:	US
Telephone Number	:	406-366-1604
Fax Number	:	406-538-4564

Provider Business Practice Location Address
First Line	:	2423 MULLAN RD
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1827
Country	:	US
Telephone Number	:	406-366-1604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	05/14/2019

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