Provider Demographics
NPI:1972366607
Name:FELLERS, KAMERON (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KAMERON
Middle Name:
Last Name:FELLERS
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 83RD ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3608
Mailing Address - Country:US
Mailing Address - Phone:806-319-5089
Mailing Address - Fax:
Practice Address - Street 1:6202 IOLA AVE STE 126
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2728
Practice Address - Country:US
Practice Address - Phone:806-319-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92698101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional