Healthcare Provider Details

I. General information

NPI: 1821369836
Provider Name (Legal Business Name): FEATHERGILL & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 PARK PL W SUITE 150
MISHAWAKA IN
46545-3561
US

IV. Provider business mailing address

3625 PARK PL W SUITE 150
MISHAWAKA IN
46545-3561
US

V. Phone/Fax

Practice location:
  • Phone: 574-282-1090
  • Fax: 866-540-3094
Mailing address:
  • Phone: 574-282-1090
  • Fax: 866-504-3094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number20041616A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number20041616A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2041616A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20041616A
License Number StateIN

VIII. Authorized Official

Name: DR. JEFFREY FEATHERGILL
Title or Position: DIRECTOR
Credential: PSY.D.
Phone: 574-282-1090