Provider Demographics
NPI:1407125743
Name:FELL, BRANDON MICHAEL (LMLP)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:FELL
Suffix:
Gender:M
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2774
Mailing Address - Country:US
Mailing Address - Phone:785-742-7113
Mailing Address - Fax:
Practice Address - Street 1:2401 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1786
Practice Address - Country:US
Practice Address - Phone:785-357-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical