Healthcare Provider Details

I. General information

NPI: 1205361680
Provider Name (Legal Business Name): HOLLY ELIZABETH PHELPS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY ELIZABETH COOKE PH.D.

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 MEDICAL CENTER DR
MORGANTOWN WV
26505-4024
US

IV. Provider business mailing address

33 MEDICAL CENTER DR
MORGANTOWN WV
26505-4024
US

V. Phone/Fax

Practice location:
  • Phone: 304-974-3798
  • Fax:
Mailing address:
  • Phone: 304-974-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1325
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: