Provider Demographics
NPI:1053986752
Name:FELTS, JACQUELINE NICHOLE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:NICHOLE
Last Name:FELTS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-2218
Mailing Address - Country:US
Mailing Address - Phone:270-904-0055
Mailing Address - Fax:270-904-5110
Practice Address - Street 1:700 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-2218
Practice Address - Country:US
Practice Address - Phone:270-904-0055
Practice Address - Fax:270-904-5110
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2595211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical