Provider Demographics
NPI:1396487492
Name:TEW, FELICIA ELIZABETH (MC LAC)
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:ELIZABETH
Last Name:TEW
Suffix:
Gender:F
Credentials:MC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 E JASPER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4245
Mailing Address - Country:US
Mailing Address - Phone:480-628-9720
Mailing Address - Fax:
Practice Address - Street 1:1121 E JASPER DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4245
Practice Address - Country:US
Practice Address - Phone:480-628-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health