Healthcare Provider Details

I. General information

NPI: 1861494452
Provider Name (Legal Business Name): MICHELLE R FELLER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELLE R FELLER LCPC

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 MULLAN RD
MISSOULA MT
59808-1827
US

IV. Provider business mailing address

1720 DINO COURT
MISSOULA MT
59808-5703
US

V. Phone/Fax

Practice location:
  • Phone: 406-366-1604
  • Fax:
Mailing address:
  • Phone: 406-366-1604
  • Fax: 406-538-4564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number959
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number959-LCPC
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: