Provider Demographics
NPI:1407518913
Name:PHELPS, TREVOR JOSEPH
Entity Type:Individual
Prefix:MR
First Name:TREVOR
Middle Name:JOSEPH
Last Name:PHELPS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 COLUMBIA AVE W
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-2848
Mailing Address - Country:US
Mailing Address - Phone:989-980-1072
Mailing Address - Fax:269-397-2261
Practice Address - Street 1:2150 COLUMBIA AVE W
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-2848
Practice Address - Country:US
Practice Address - Phone:989-980-1072
Practice Address - Fax:269-397-2261
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851111333104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker