Provider Demographics
NPI:1083689285
Name:YVONNE FELLERS INC
Entity Type:Organization
Organization Name:YVONNE FELLERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:E
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:FELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:903-838-3322
Mailing Address - Street 1:PO BOX 6447
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505
Mailing Address - Country:US
Mailing Address - Phone:903-838-3322
Mailing Address - Fax:903-838-9034
Practice Address - Street 1:3400 ST MICHAEL DRIVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-838-3322
Practice Address - Fax:903-838-9034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSO20231041C0700X
ARC 5891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OOS78LMedicare ID - Type Unspecified