Provider Demographics
NPI:1174873608
Name:PHELPS, HEATHER RANDALL (MA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RANDALL
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 6TH AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2165
Mailing Address - Country:US
Mailing Address - Phone:907-677-7709
Mailing Address - Fax:907-677-7095
Practice Address - Street 1:700 W 6TH AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2165
Practice Address - Country:US
Practice Address - Phone:907-677-7709
Practice Address - Fax:907-677-7095
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional