Provider Demographics
NPI:1457697385
Name:FELLER, JANICE (LPC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:FELLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5955 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9101
Mailing Address - Country:US
Mailing Address - Phone:269-525-4374
Mailing Address - Fax:269-210-2484
Practice Address - Street 1:5955 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-9101
Practice Address - Country:US
Practice Address - Phone:269-525-4374
Practice Address - Fax:269-210-2484
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013197101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401013197OtherLICENSE #