Healthcare Provider Details

I. General information

NPI: 1467773077
Provider Name (Legal Business Name): JODI LEE FELLERS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SCHNEIDER ST NE DOOR 6
CANTON OH
44721-3349
US

IV. Provider business mailing address

12018 SNODE ST NE
ALLIANCE OH
44601-9665
US

V. Phone/Fax

Practice location:
  • Phone: 330-470-4061
  • Fax:
Mailing address:
  • Phone: 330-821-2648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0005777
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: