1962624163 NPI number — FELICIA L PHELPS MSSA LISW

Table of content: FELICIA L PHELPS MSSA LISW (NPI 1962624163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962624163 NPI number — FELICIA L PHELPS MSSA LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS
Provider First Name:
FELICIA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSSA LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962624163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 GLACIERVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44509-1928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-288-9895
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5330 E MAIN ST STE 100B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-626-0034
Provider Business Practice Location Address Fax Number:
614-230-2316
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I.0008220-SUPV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0255670 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: I.0008220-SUPV . This is a "CSWMFT BOARD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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