Provider Demographics
NPI:1184004467
Name:FELTS, CHRISTINE MICHELLE TAYLOR (ATR, LPCC, JSOCC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MICHELLE TAYLOR
Last Name:FELTS
Suffix:
Gender:F
Credentials:ATR, LPCC, JSOCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 GOLDEN MAPLE CV
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5515
Mailing Address - Country:US
Mailing Address - Phone:502-386-2607
Mailing Address - Fax:
Practice Address - Street 1:11103 PARK RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2424
Practice Address - Country:US
Practice Address - Phone:502-752-5542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00218323101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional