Provider Demographics
NPI:1184740227
Name:PHELAN, JEANNETTE LOUISE (LMFT)
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:LOUISE
Last Name:PHELAN
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 1:4115 55TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3057
Mailing Address - Country:US
Mailing Address - Phone:916-457-6845
Mailing Address - Fax:
Practice Address - Street 1:2740 FULTON AVE STE 211
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-5187
Practice Address - Country:US
Practice Address - Phone:916-448-3301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC24770106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist