Provider Demographics
NPI:1457148165
Name:FELLOWS, CANDACE JO (LMHC)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:JO
Last Name:FELLOWS
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46915-9441
Mailing Address - Country:US
Mailing Address - Phone:765-490-3267
Mailing Address - Fax:
Practice Address - Street 1:322 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4622
Practice Address - Country:US
Practice Address - Phone:765-776-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005445A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health