Provider Demographics
NPI:1336430370
Name:FELLENSTEIN, LEAH M (PC)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:M
Last Name:FELLENSTEIN
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:M
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:8437 MAYFIELD RD STE 102UP
Mailing Address - Street 2:
Mailing Address - City:CHESTERLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44026-2584
Mailing Address - Country:US
Mailing Address - Phone:440-490-4011
Mailing Address - Fax:
Practice Address - Street 1:8437 MAYFIELD RD STE 102UP
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2584
Practice Address - Country:US
Practice Address - Phone:440-490-4011
Practice Address - Fax:440-490-3355
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.09000653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0154533Medicaid