| Doctor Name: | MR. JASON ROBERT PHELAN |
| NPI Number: | 1053734897 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA-ADP |
| License Number: | |
| Business Practice Address: | 975 Solomons Island Rd N Prince Frederick, MD - 206783917 |
| Business Phone Number: | 4105353079 |
| Business Fax Number: | 4105352220 |
| Mailing Address: | Po Box 1158, PRINCE FREDERICK |
| State: | MD |
| Postal Code: | 206781158 |
| Phone Number: | 4105353079 |
| Fax Number: | 4105352220 |
| NPI Enumeration Date: | 01/30/2014 |
| NPI Last Update Date: | 01/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |