Provider Demographics
NPI:1225173719
Name:FELLERS, STACY (LPCC-S)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FELLERS
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5735 MEEKER RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-1186
Mailing Address - Country:US
Mailing Address - Phone:937-548-3806
Mailing Address - Fax:937-548-2087
Practice Address - Street 1:1101 JACKSON ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1395
Practice Address - Country:US
Practice Address - Phone:937-547-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-11-16
Deactivation Date:2007-03-13
Deactivation Code:
Reactivation Date:2007-05-09
Provider Licenses
StateLicense IDTaxonomies
OHE.0003669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional