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General NPI Number Information
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NPI Number | 1437252079
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Entity Type | Individual
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Provider Name | TIMOTHY W PHELPS LMFT, LADC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4301 MOW WAY RD BLGD #4600 SWS 3 WEST
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City | FORT SILL
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State | OK
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Zip | 73503-6300
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Country | US
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Telephone | 580-458-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 321 SW 72ND ST
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City | LAWTON
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State | OK
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Zip | 73505-6621
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Country | US
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Telephone | 580-536-4512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 213
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License Number State | OK
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