Provider Demographics
NPI:1174060701
Name:FELLOWS, DENISE BELLA (LCSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:BELLA
Last Name:FELLOWS
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 1:932 NE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-3106
Mailing Address - Country:US
Mailing Address - Phone:503-879-2026
Mailing Address - Fax:
Practice Address - Street 1:932 NE 18TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3106
Practice Address - Country:US
Practice Address - Phone:503-472-2233
Practice Address - Fax:503-472-2299
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health