Provider Demographics
NPI:1215724877
Name:PHELPS, FAITH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:PHELPS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 CONGRESSIONAL BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5644
Mailing Address - Country:US
Mailing Address - Phone:765-484-6196
Mailing Address - Fax:
Practice Address - Street 1:3777 HALEY DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2608
Practice Address - Country:US
Practice Address - Phone:812-490-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician