Provider Demographics
NPI:1962865121
Name:FELLER, AMY (ACMHC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FELLER
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7476 S 1000 E
Mailing Address - Street 2:4F
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-2946
Mailing Address - Country:US
Mailing Address - Phone:801-580-9717
Mailing Address - Fax:
Practice Address - Street 1:5689 S REDWOOD RD
Practice Address - Street 2:4F
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5447
Practice Address - Country:US
Practice Address - Phone:801-580-9717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5086711-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health