Provider Demographics
NPI:1922389741
Name:PHELPS, ASHLEY JO (PHD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:JO
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 W 4TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3177
Mailing Address - Country:US
Mailing Address - Phone:719-545-3814
Mailing Address - Fax:
Practice Address - Street 1:803 W 4TH ST STE F
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3177
Practice Address - Country:US
Practice Address - Phone:719-545-3814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3316103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist