Provider Demographics
NPI:1235147679
Name:FELTON, STACIE KENDRA (PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:KENDRA
Last Name:FELTON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5617
Mailing Address - Country:US
Mailing Address - Phone:402-721-7169
Mailing Address - Fax:402-721-7189
Practice Address - Street 1:445 E 1ST ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5617
Practice Address - Country:US
Practice Address - Phone:402-721-7169
Practice Address - Fax:402-721-7189
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7859101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025115400Medicaid