Provider Demographics
NPI:1245249564
Name:PHELPS, CAROL MCEWEN (PH D LMFT)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:MCEWEN
Last Name:PHELPS
Suffix:
Gender:F
Credentials:PH D LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 CEDAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-4905
Mailing Address - Country:US
Mailing Address - Phone:214-528-3007
Mailing Address - Fax:214-521-7334
Practice Address - Street 1:3609 CEDAR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4905
Practice Address - Country:US
Practice Address - Phone:214-528-3007
Practice Address - Fax:214-521-7334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028556101Medicaid