Provider Demographics
NPI:1750975777
Name:FELLOWS, KATHRYN (LPC NCC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WACONIA RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07422-1700
Mailing Address - Country:US
Mailing Address - Phone:917-704-8651
Mailing Address - Fax:
Practice Address - Street 1:216 WACONIA RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07422-1700
Practice Address - Country:US
Practice Address - Phone:917-704-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00751000103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling