Provider Demographics
NPI:1558118240
Name:PHELPS, ABIGAIL KATHRYN
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:KATHRYN
Last Name:PHELPS
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 1:1280 OFFICE PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2300
Mailing Address - Country:US
Mailing Address - Phone:515-446-3420
Mailing Address - Fax:
Practice Address - Street 1:1280 OFFICE PLAZA DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-2300
Practice Address - Country:US
Practice Address - Phone:515-446-3420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor