Provider Demographics
NPI:1659457588
Name:PHELPS, CHERYL A (MA LSWA LPC LMFT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MA LSWA LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 S LEWIS 190
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-742-3133
Mailing Address - Fax:918-742-7677
Practice Address - Street 1:4870 S LEWIS 190
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105
Practice Address - Country:US
Practice Address - Phone:918-742-3133
Practice Address - Fax:918-742-7677
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK966101Y00000X
OK0860104100000X
OK454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist