Provider Demographics
NPI:1073819223
Name:PHELPS, CARRIE LYNN
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:LYNN
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 1:1748 INDENPDENCE BLVD.
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234
Mailing Address - Country:US
Mailing Address - Phone:941-462-9829
Mailing Address - Fax:941-359-1929
Practice Address - Street 1:1748 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE D-1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2122
Practice Address - Country:US
Practice Address - Phone:941-462-9829
Practice Address - Fax:941-359-1929
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health