Provider Demographics
NPI:1790152486
Name:PHELPS, COLEEN BAIRD (LPC)
Entity Type:Individual
Prefix:
First Name:COLEEN
Middle Name:BAIRD
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 BENTON ST.
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401
Mailing Address - Country:US
Mailing Address - Phone:208-523-2490
Mailing Address - Fax:208-522-2603
Practice Address - Street 1:1301 MAIN ST.
Practice Address - Street 2:SUITE 3B
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467
Practice Address - Country:US
Practice Address - Phone:208-756-2927
Practice Address - Fax:208-756-1518
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional