Doctor Name: | DR. KELLY CARL FELLER |
NPI Number: | 1134417132 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD, LCSW |
License Number: | 7057775-3501 |
Business Practice Address: | 537 W 2600 S Suite 203 Bountiful, UT - 840107779 |
Business Phone Number: | 8018091049 |
Business Fax Number: | |
Mailing Address: | 1048 E Fairway Dr, NORTH SALT LAKE |
State: | UT |
Postal Code: | 840543056 |
Phone Number: | 8018091049 |
Fax Number: | |
NPI Enumeration Date: | 07/12/2011 |
NPI Last Update Date: | 07/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 7057775-3501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |