Provider Demographics
NPI:1932213576
Name:FELLERS, JAY DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:DANIEL
Last Name:FELLERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 S LOCUST ST
Mailing Address - Street 2:SUITE 113
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-7126
Mailing Address - Country:US
Mailing Address - Phone:303-947-4071
Mailing Address - Fax:303-753-4650
Practice Address - Street 1:2755 S LOCUST ST
Practice Address - Street 2:SUITE 113
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-7126
Practice Address - Country:US
Practice Address - Phone:303-947-4071
Practice Address - Fax:303-753-4650
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9912581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical