Provider Demographics
NPI:1942851753
Name:PHELAN, PATRICK (MA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:PHELAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9939 SW 184TH WAY
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-5252
Mailing Address - Country:US
Mailing Address - Phone:314-920-5557
Mailing Address - Fax:
Practice Address - Street 1:9939 SW 184TH WAY
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5252
Practice Address - Country:US
Practice Address - Phone:314-920-5557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor