Provider Demographics
NPI:1568817518
Name:FELLOWS, ASHLEY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARIE
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1798 E RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65202-3329
Mailing Address - Country:US
Mailing Address - Phone:573-554-6057
Mailing Address - Fax:
Practice Address - Street 1:2600 FORUM BLVD STE G
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6343
Practice Address - Country:US
Practice Address - Phone:673-239-9915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-27
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040361101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1568817518Medicaid
MO101YA0400XMedicaid