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General NPI Number Information
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NPI Number | 1457148165
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Entity Type | Individual
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Provider Name | CANDACE JO FELLOWS LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 322 N MAIN ST
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City | KOKOMO
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State | IN
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Zip | 46901-4622
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Country | US
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Telephone | 765-776-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 608 E 7TH ST
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City | BURLINGTON
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State | IN
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Zip | 46915-9441
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Country | US
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Telephone | 765-490-3267
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 39005445A
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License Number State | IN
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