Audrey Renee Fellows, L.M.H.C

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

39003063A Issued in IN

Practice address

912 E Lasalle Ave
South Bend, IN 46617-2817

Phone

(574) 231-8000

Fax

(574) 231-8013

NPI assigned

Aug 25, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Audrey Renee Miller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fellows Counseling & Consulting

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Buchanan, MI
  • NPI 1871366583
  NPD Authorized official
• Behavior Services & Therapy, Inc.

  • Community/Behavioral Health Agency
  • South Bend, IN
  • NPI 1659555852
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1497272975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 E LASALLE AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172817",
            "telephone_number": "574-231-8000",
            "fax_number": "574-231-8013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 E LASALLE AVE",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172817",
            "telephone_number": "574-231-8000",
            "fax_number": "574-231-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELLOWS",
        "first_name": "AUDREY",
        "middle_name": "RENEE",
        "credential": "L.M.H.C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-25",
        "last_updated": "2022-07-21",
        "certification_date": "2021-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39003063A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AUDREY",
            "last_name": "MILLER",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Billie Rae Federspiel, NP
• Thomas Allen Felger, M.D.
• Daysha Bliss Feliciano
• Payton Fell
• Molly Lynn Feller
• Eugene Michael Feltman, DDS., MSD
• Carrie Felty, BCBA
• Destiny Maria Lynn Fender
• Jeffrey Michael Fenimore, RPH
• Brionne Denay Fergison

• Mental Health Counselor in South Bend, IN
• Providers in South Bend, IN by specialty
• Mental Health Counselor in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.