Provider Demographics
NPI:1205361680
Name:PHELPS, HOLLY ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ELIZABETH
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:ELIZABETH
Other - Last Name:COOKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:33 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-4024
Mailing Address - Country:US
Mailing Address - Phone:304-974-3798
Mailing Address - Fax:
Practice Address - Street 1:33 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-4024
Practice Address - Country:US
Practice Address - Phone:304-974-3798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1325103G00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health