Provider Demographics
NPI:1962887489
Name:FELIX, DEIDRE KATHLEEN
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:KATHLEEN
Last Name:FELIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MISSISSIPPI AVE NW
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4326
Mailing Address - Country:US
Mailing Address - Phone:850-244-2606
Mailing Address - Fax:
Practice Address - Street 1:109 MISSISSIPPI AVE NW
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4326
Practice Address - Country:US
Practice Address - Phone:850-244-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-26
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor