Provider Demographics
NPI:1972219517
Name:FELTT, EMILY ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:FELTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 E COUNTY ROAD 450 N
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-9264
Mailing Address - Country:US
Mailing Address - Phone:765-499-1400
Mailing Address - Fax:
Practice Address - Street 1:4908 E COUNTY ROAD 450 N
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-9264
Practice Address - Country:US
Practice Address - Phone:765-499-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008585A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34009612AMedicaid
IN33008585AMedicaid