Basic Information
| Provider Information | |||||||||
| NPI: | 1942851753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHELAN | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | |||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9939 SW 184TH WAY | ||||||||
| Address2: | |||||||||
| City: | VASHON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980705252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149205557 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9939 SW 184TH WAY | ||||||||
| Address2: | |||||||||
| City: | VASHON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980705252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149205557 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2019 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.