Provider Demographics
NPI:1831635911
Name:FELTS, GLENDA (LMSW-33529)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:
Last Name:FELTS
Suffix:
Gender:F
Credentials:LMSW-33529
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14775 N KIMO CT
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-8762
Mailing Address - Country:US
Mailing Address - Phone:208-687-0538
Mailing Address - Fax:
Practice Address - Street 1:700 W IRONWOOD DR STE 130
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4404
Practice Address - Country:US
Practice Address - Phone:208-625-4700
Practice Address - Fax:208-625-4701
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-427551041C0700X
IDLMSW335291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty