Provider Demographics
NPI:1275649659
Name:PHELAN, CHERYLE LYNNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYLE
Middle Name:LYNNE
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 W COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOVINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:88260-2641
Mailing Address - Country:US
Mailing Address - Phone:480-452-5695
Mailing Address - Fax:
Practice Address - Street 1:1600 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-2830
Practice Address - Country:US
Practice Address - Phone:575-396-6611
Practice Address - Fax:575-396-0318
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ125361041C0700X
NMC088901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical