Provider Demographics
NPI:1245714625
Name:PHELAN, ANNEMARIE (MS, LMHC)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:
Last Name:PHELAN
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3424
Mailing Address - Country:US
Mailing Address - Phone:561-236-1789
Mailing Address - Fax:
Practice Address - Street 1:1555 PALM BEACH LAKES BLVD STE 1560
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2335
Practice Address - Country:US
Practice Address - Phone:772-266-7923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15185101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health