Provider Demographics
NPI:1285686089
Name:FELLOWS, ADAM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SW LONGVIEW BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2112
Mailing Address - Country:US
Mailing Address - Phone:816-761-3944
Mailing Address - Fax:866-335-7993
Practice Address - Street 1:400 SW LONGVIEW BLVD STE 160
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2112
Practice Address - Country:US
Practice Address - Phone:816-761-3944
Practice Address - Fax:866-335-7993
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007029990103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical