Provider Demographics
NPI:1194232538
Name:PHELAN, SEAN MICHAEL
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:MICHAEL
Last Name:PHELAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7530 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4132
Mailing Address - Country:US
Mailing Address - Phone:305-271-8790
Mailing Address - Fax:
Practice Address - Street 1:11055 SW 186TH ST STE 306
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6843
Practice Address - Country:US
Practice Address - Phone:786-224-6884
Practice Address - Fax:786-688-2483
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
FLMH21231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician