Healthcare Provider Details

I. General information

NPI: 1598184335
Provider Name (Legal Business Name): DEBORAH PHELPS MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 E CEDAR CREST DR
BLOOMINGTON IN
47401-9208
US

IV. Provider business mailing address

4919 E CEDAR CREST DR
BLOOMINGTON IN
47401-9208
US

V. Phone/Fax

Practice location:
  • Phone: 812-219-6259
  • Fax:
Mailing address:
  • Phone: 812-219-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: