Provider Demographics
NPI:1366075079
Name:PHELPS, SHARLA J (LMSW)
Entity type:Individual
Prefix:
First Name:SHARLA
Middle Name:J
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0743
Mailing Address - Country:US
Mailing Address - Phone:208-230-0164
Mailing Address - Fax:
Practice Address - Street 1:620 S IDAHO AVE
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2607
Practice Address - Country:US
Practice Address - Phone:208-452-7190
Practice Address - Fax:208-452-5819
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-39058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker