MEDICARE: MR. ERIC I PHELPS PHD, LCSW, CGP

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	1041C0700X	Clinical Social Worker	2293-C	AR

General Provider Information

NPI Number	:	1679609937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC I PHELPS PHD, LCSW, CGP

Provider Business Mailing Address
First Line	:	1922 PINE VALLEY RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-1817
Country	:	US
Telephone Number	:	501-680-4239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1922 PINE VALLEY RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-1817
Country	:	US
Telephone Number	:	501-680-4239
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/02/2013

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