Provider Demographics
NPI:1215319561
Name:FELTS, LOREN LARAE (BA)
Entity type:Individual
Prefix:MISS
First Name:LOREN
Middle Name:LARAE
Last Name:FELTS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2530 S COMMERCE ST
Mailing Address - Street 2:BLDG. B
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5519
Mailing Address - Country:US
Mailing Address - Phone:580-223-5636
Mailing Address - Fax:580-226-6727
Practice Address - Street 1:2530 S COMMERCE ST
Practice Address - Street 2:BLDG. B
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5519
Practice Address - Country:US
Practice Address - Phone:580-223-5636
Practice Address - Fax:580-226-6727
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health