Provider Demographics
NPI:1134770795
Name:PHELPS, JANIS MAYO (LMFT)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:MAYO
Last Name:PHELPS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1044
Mailing Address - Street 2:
Mailing Address - City:HIGLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85236-1044
Mailing Address - Country:US
Mailing Address - Phone:951-317-0818
Mailing Address - Fax:
Practice Address - Street 1:690 E WARNER RD STE 152
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3059
Practice Address - Country:US
Practice Address - Phone:804-282-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15339106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist