Provider Demographics
NPI:1952360661
Name:FELTY, RACHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:
Last Name:FELTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3700
Mailing Address - Country:US
Mailing Address - Phone:502-629-3475
Mailing Address - Fax:502-629-3455
Practice Address - Street 1:3991 DUTCHMANS LANE
Practice Address - Street 2:SUITE 405
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-2670
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY08571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCK5471OtherRAIROAD MEDICARE
KY7100137520Medicaid
KY800013959OtherRAILROAD MEDICARE
KY7100137520Medicaid