Provider Demographics
NPI:1750586244
Name:PHELPS, LISA (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 MAYWOOD PL
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-1702
Mailing Address - Country:US
Mailing Address - Phone:662-902-1420
Mailing Address - Fax:662-624-4155
Practice Address - Street 1:223 SHARKEY AVE
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4497
Practice Address - Country:US
Practice Address - Phone:662-902-1420
Practice Address - Fax:662-624-4155
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS254101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health