Provider Demographics
NPI:1760824668
Name:FELLER, EMILY
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:FELLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 N GREENWOOD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-1446
Mailing Address - Country:US
Mailing Address - Phone:918-599-7277
Mailing Address - Fax:918-599-7716
Practice Address - Street 1:130 N GREENWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120
Practice Address - Country:US
Practice Address - Phone:918-599-7277
Practice Address - Fax:918-599-7716
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKG082621963390200000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program