Provider Demographics
NPI:1962737361
Name:FELTON, GALYCE LAWRENCE
Entity type:Individual
Prefix:
First Name:GALYCE
Middle Name:LAWRENCE
Last Name:FELTON
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:PO BOX 16906
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-6906
Mailing Address - Country:US
Mailing Address - Phone:602-279-1427
Mailing Address - Fax:602-279-1431
Practice Address - Street 1:2702 N 3RD ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1130
Practice Address - Country:US
Practice Address - Phone:602-279-1427
Practice Address - Fax:602-279-1431
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1766794104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker