Provider Demographics
NPI:1669429932
Name:FELLENZ, ALISON LYNN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:LYNN
Last Name:FELLENZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HOSTA CT
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2476
Mailing Address - Country:US
Mailing Address - Phone:215-918-2733
Mailing Address - Fax:
Practice Address - Street 1:1240 S BROAD ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-5395
Practice Address - Country:US
Practice Address - Phone:215-699-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000459106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist