Provider Demographics
NPI:1619037991
Name:FELLEN, HELENE K (MA)
Entity Type:Individual
Prefix:MS
First Name:HELENE
Middle Name:K
Last Name:FELLEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6721 ACADEMY RD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3393
Mailing Address - Country:US
Mailing Address - Phone:505-247-9663
Mailing Address - Fax:505-856-2411
Practice Address - Street 1:6721 ACADEMY RD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3393
Practice Address - Country:US
Practice Address - Phone:505-247-9663
Practice Address - Fax:505-856-2411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0435106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM181070Medicare UPIN