Provider Demographics
NPI:1649811670
Name:FELLBAUM-WRIGHT, TAYLOR E (MS, LPCC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:E
Last Name:FELLBAUM-WRIGHT
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:E
Other - Last Name:FELLBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW STE 110
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-379-1756
Mailing Address - Fax:
Practice Address - Street 1:1702 MILLER TRUNK HWY STE 2
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4443
Practice Address - Country:US
Practice Address - Phone:218-524-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health