Provider Demographics
NPI:1316818818
Name:PHEA, CHANNRA D
Entity type:Individual
Prefix:
First Name:CHANNRA
Middle Name:D
Last Name:PHEA
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 1:8450 67TH AVE NE UNIT D102
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-7995
Mailing Address - Country:US
Mailing Address - Phone:425-501-7440
Mailing Address - Fax:
Practice Address - Street 1:3810 166TH PL NE STE 202B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8403
Practice Address - Country:US
Practice Address - Phone:425-949-0801
Practice Address - Fax:866-764-2841
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician