Provider Demographics
NPI:1679291926
Name:PHELPS, COURTNEY SAMANTHA
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:SAMANTHA
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 GRAPHICS WAY STE 3100
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-1123
Mailing Address - Country:US
Mailing Address - Phone:740-428-0428
Mailing Address - Fax:740-909-4077
Practice Address - Street 1:450 W WILSON BRIDGE RD STE 350
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-5220
Practice Address - Country:US
Practice Address - Phone:614-245-5119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2300339-TRNE106H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator