Provider Demographics
NPI:1861641102
Name:MOORKOTH-PHELPS, PRIYA (MA)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:
Last Name:MOORKOTH-PHELPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:KONCHADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2579 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-903-1215
Mailing Address - Fax:510-830-3398
Practice Address - Street 1:300 BRADFORD ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1530
Practice Address - Country:US
Practice Address - Phone:650-599-1739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health