Provider Demographics
NPI:1780160465
Name:FELLOWS, CHASTITY T
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:T
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 1:1584 W ORLEANS AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2736
Mailing Address - Country:US
Mailing Address - Phone:559-727-3088
Mailing Address - Fax:
Practice Address - Street 1:1584 W. ORLEANS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-9370
Practice Address - Country:US
Practice Address - Phone:559-727-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst