Provider Demographics
NPI:1689996092
Name:JAY D FELLERS LCSW PC
Entity Type:Organization
Organization Name:JAY D FELLERS LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:D
Authorized Official - Last Name:FELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:303-947-4071
Mailing Address - Street 1:2755 S LOCUST ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7126
Mailing Address - Country:US
Mailing Address - Phone:303-947-4071
Mailing Address - Fax:303-753-4650
Practice Address - Street 1:2755 S LOCUST ST
Practice Address - Street 2:SUITE 113
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7126
Practice Address - Country:US
Practice Address - Phone:303-947-4071
Practice Address - Fax:303-753-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20081337835251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health