Provider Demographics
NPI:1649678368
Name:FELLOWS, CAMI
Entity type:Individual
Prefix:
First Name:CAMI
Middle Name:
Last Name:FELLOWS
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 1:75 S 1ST W
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:ID
Mailing Address - Zip Code:83263-1204
Mailing Address - Country:US
Mailing Address - Phone:208-852-2370
Mailing Address - Fax:208-852-5570
Practice Address - Street 1:75 S 1ST W
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:ID
Practice Address - Zip Code:83263-1204
Practice Address - Country:US
Practice Address - Phone:208-852-2370
Practice Address - Fax:208-852-5570
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health