Provider Demographics
NPI:1174254577
Name:FELTON, PHYLICIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:PHYLICIA
Middle Name:
Last Name:FELTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5227 ROBLE GRANDE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-1712
Mailing Address - Country:US
Mailing Address - Phone:915-630-1170
Mailing Address - Fax:
Practice Address - Street 1:6333 DE ZAVALA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2115
Practice Address - Country:US
Practice Address - Phone:210-399-4838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84132101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional