Healthcare Provider Details

I. General information

NPI: 1174254577
Provider Name (Legal Business Name): PHYLICIA FELTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 DE ZAVALA RD
SAN ANTONIO TX
78249-2115
US

IV. Provider business mailing address

5227 ROBLE GRANDE
SAN ANTONIO TX
78261-1712
US

V. Phone/Fax

Practice location:
  • Phone: 210-399-4838
  • Fax:
Mailing address:
  • Phone: 915-630-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: