Provider Demographics
NPI:1386992162
Name:PHELPS, EILEEN ANNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:ANNE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14499 N DALE MABRY HWY STE 130S
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-2071
Mailing Address - Country:US
Mailing Address - Phone:833-769-3524
Mailing Address - Fax:
Practice Address - Street 1:14499 N DALE MABRY HWY STE 130S
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2071
Practice Address - Country:US
Practice Address - Phone:833-769-3524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health