Healthcare Provider Details

I. General information

NPI: 1689119422
Provider Name (Legal Business Name): MADELYNN FELLON MA. LPC, LMFT, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 JEFFERSON HWY STE E
JEFFERSON LA
70121-3835
US

IV. Provider business mailing address

1901 JEFFERSON HWY STE E
JEFFERSON LA
70121-3835
US

V. Phone/Fax

Practice location:
  • Phone: 504-457-8341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6907
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT1319
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: