Provider Demographics
NPI:1538981980
Name:PHELAN, JADEN TROY
Entity type:Individual
Prefix:
First Name:JADEN
Middle Name:TROY
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 1:2321 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64503-2828
Mailing Address - Country:US
Mailing Address - Phone:816-294-6007
Mailing Address - Fax:
Practice Address - Street 1:702 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:MO
Practice Address - Zip Code:64473-9657
Practice Address - Country:US
Practice Address - Phone:816-294-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty