Provider Demographics
NPI:1275634560
Name:PHELPS, JUNE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:L
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-4303
Mailing Address - Country:US
Mailing Address - Phone:330-456-3397
Mailing Address - Fax:
Practice Address - Street 1:101 CLEVELAND AVE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44702-1700
Practice Address - Country:US
Practice Address - Phone:330-454-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5622103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent