Provider Demographics
NPI:1568890150
Name:PHELPS, DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PHELPS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 S WENTWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3016
Mailing Address - Country:US
Mailing Address - Phone:414-807-6216
Mailing Address - Fax:
Practice Address - Street 1:401 E KILBOURN AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3212
Practice Address - Country:US
Practice Address - Phone:414-269-8690
Practice Address - Fax:414-269-8657
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3179-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist