Provider Demographics
NPI:1841502721
Name:PHELAN, CANDACE MARTIN (LCPC)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:MARTIN
Last Name:PHELAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1437
Mailing Address - Country:US
Mailing Address - Phone:630-702-9006
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST
Practice Address - Street 2:STE. 107B
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2080
Practice Address - Country:US
Practice Address - Phone:630-234-7395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional