Provider Demographics
NPI:1346360187
Name:PHELPS, MARSHA IRENE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:IRENE
Last Name:PHELPS
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 1:429 WEST 10TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2941
Mailing Address - Country:US
Mailing Address - Phone:719-544-4233
Mailing Address - Fax:719-544-4215
Practice Address - Street 1:429 WEST 10TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2941
Practice Address - Country:US
Practice Address - Phone:719-544-4233
Practice Address - Fax:719-544-4215
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO035195Medicaid