Provider Demographics
NPI:1962624163
Name:PHELPS, FELICIA L (MSSA LISW)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:L
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MSSA LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 GLACIERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1928
Mailing Address - Country:US
Mailing Address - Phone:614-288-9895
Mailing Address - Fax:
Practice Address - Street 1:30 NORTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1808
Practice Address - Country:US
Practice Address - Phone:330-633-4187
Practice Address - Fax:330-633-4294
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 0008220104100000X
OHI.0008220-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI.0008220-SUPVOtherCSWMFT BOARD