Provider Demographics
NPI:1093186967
Name:PHELPS, STACEY
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
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 1:1799 STUMPF BLVD BLDG 2
Mailing Address - Street 2:
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3950
Mailing Address - Country:US
Mailing Address - Phone:504-432-1591
Mailing Address - Fax:504-301-3364
Practice Address - Street 1:1799 STUMPF BLVD
Practice Address - Street 2:BLDG 2 STE 4-A
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056
Practice Address - Country:US
Practice Address - Phone:504-301-0811
Practice Address - Fax:504-301-3364
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor