Provider Demographics
NPI:1861494452
Name:FELLER, MICHELLE R (LCPC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:R
Last Name:FELLER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:FELLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:1720 DINO COURT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5703
Mailing Address - Country:US
Mailing Address - Phone:406-366-1604
Mailing Address - Fax:406-538-4564
Practice Address - Street 1:2423 MULLAN RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1827
Practice Address - Country:US
Practice Address - Phone:406-366-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT959101YP2500X
MT959-LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
F1081OtherAPS HEALTHCARE
744623OtherBLUECROSS/BLUESHIELD
MT0253198Medicaid