Provider Demographics
NPI:1679609937
Name:PHELPS, ERIC I (PHD, LCSW, CGP)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:I
Last Name:PHELPS
Suffix:
Gender:M
Credentials:PHD, LCSW, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72207-1817
Mailing Address - Country:US
Mailing Address - Phone:501-680-4239
Mailing Address - Fax:
Practice Address - Street 1:1922 PINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72207-1817
Practice Address - Country:US
Practice Address - Phone:501-680-4239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2293-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical