Provider Demographics
NPI:1417423229
Name:FELTON, IAN D (LPC)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:D
Last Name:FELTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 DOUGLAS AVE APT 1007
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3198
Mailing Address - Country:US
Mailing Address - Phone:612-232-9677
Mailing Address - Fax:
Practice Address - Street 1:700 DOUGLAS AVE APT 1007
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3198
Practice Address - Country:US
Practice Address - Phone:612-293-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional