Provider Demographics
NPI:1265648364
Name:FENELL, DAVID LEROY (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEROY
Last Name:FENELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7665 YELLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-6622
Mailing Address - Country:US
Mailing Address - Phone:719-590-1252
Mailing Address - Fax:719-262-4110
Practice Address - Street 1:UNIVERSITY OF COLORADO COLLEGE OF EDUCATION
Practice Address - Street 2:1420 AUSTIN BLUFFS PARKWAY
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80933-7150
Practice Address - Country:US
Practice Address - Phone:719-262-4096
Practice Address - Fax:719-262-4110
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYCHOLOGIST-1055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist