Provider Demographics
NPI:1023208642
Name:PHELPS, JACQULYN CHRISTINE (LPC)
Entity Type:Individual
Prefix:
First Name:JACQULYN
Middle Name:CHRISTINE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:912 S KINGSHIGHWAY ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4416
Mailing Address - Country:US
Mailing Address - Phone:573-370-1178
Mailing Address - Fax:573-370-1261
Practice Address - Street 1:760 PLANTATION BLVD
Practice Address - Street 2:BOX 1043
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5736
Practice Address - Country:US
Practice Address - Phone:573-471-0800
Practice Address - Fax:573-471-0810
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007021153101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional