Provider Demographics
NPI:1790896751
Name:PHELPS, DOROTHY JEAN (M ED)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:JEAN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BRYAN DRIVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701
Mailing Address - Country:US
Mailing Address - Phone:580-924-0066
Mailing Address - Fax:580-924-1551
Practice Address - Street 1:1400 BRYAN DRIVE
Practice Address - Street 2:SUITE 305
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701
Practice Address - Country:US
Practice Address - Phone:580-924-0066
Practice Address - Fax:580-924-1551
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0048101Y00000X
OK0042101Y00000X
TX9832101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor