Basic Information
| Provider Information | |||||||||
| NPI: | 1982128724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHELPS | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | N | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1230 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477061230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124506879 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 445 N CROSS POINTE BLVD | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477154010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124714611 | ||||||||
| FaxNumber: | 8124714514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2017 | ||||||||
| LastUpdateDate: | 08/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34007828A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.