Healthcare Provider Details

I. General information

NPI: 1386134781
Provider Name (Legal Business Name): MELISSA ANN PHELPS MA, CT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 PAYNE AVE
CLEVELAND OH
44114-2910
US

IV. Provider business mailing address

1744 PAYNE AVE
CLEVELAND OH
44114-2910
US

V. Phone/Fax

Practice location:
  • Phone: 216-623-6555
  • Fax: 216-623-6539
Mailing address:
  • Phone: 216-623-6555
  • Fax: 216-623-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.1801049
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1902295
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: