Provider Demographics
NPI:1023867892
Name:PHELPS, TRINA
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37861-0062
Mailing Address - Country:US
Mailing Address - Phone:828-712-8056
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 62
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:TN
Practice Address - Zip Code:37861-0062
Practice Address - Country:US
Practice Address - Phone:828-712-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician