Provider Demographics
NPI:1184152126
Name:FELLS, JESSINA MOETTE
Entity type:Individual
Prefix:
First Name:JESSINA
Middle Name:MOETTE
Last Name:FELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38105 POST OFFICE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4296
Mailing Address - Country:US
Mailing Address - Phone:225-402-2436
Mailing Address - Fax:225-302-5825
Practice Address - Street 1:4100 S SHERWOOD FOREST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0008
Practice Address - Country:US
Practice Address - Phone:225-402-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional