MEDICARE: MR. TIMOTHY W PHELPS LMFT, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	213	OK

General Provider Information

NPI Number	:	1437252079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY W PHELPS LMFT, LADC

Provider Business Mailing Address
First Line	:	321 SW 72ND ST
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-6621
Country	:	US
Telephone Number	:	580-536-4512
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 MOW WAY RD
Second Line	:	BLGD #4600 SWS 3 WEST
City	:	FORT SILL
State	:	OK
Zip	:	73503-6300
Country	:	US
Telephone Number	:	580-458-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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