| Doctor Name: | MR. JUDSON H. PHELPS |
| NPI Number: | 1023144003 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LADC 1 |
| License Number: | 523 |
| Business Practice Address: | 200 Ter Heun Dr Falmouth, MA - 025402525 |
| Business Phone Number: | 5085406550 |
| Business Fax Number: | 5085407480 |
| Mailing Address: | 53 Gingerbread Ln, YARMOUTH PORT |
| State: | MA |
| Postal Code: | 026751110 |
| Phone Number: | 5083625921 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 523 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |