| Doctor Name: | COLEEN BAIRD PHELPS |
| NPI Number: | 1790152486 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | |
| Business Practice Address: | 1301 Main St. Suite 3b Salmon, ID - 83467 |
| Business Phone Number: | 2087562927 |
| Business Fax Number: | 2087561518 |
| Mailing Address: | 1380 Benton St., IDAHO FALLS |
| State: | ID |
| Postal Code: | 83401 |
| Phone Number: | 2085232490 |
| Fax Number: | 2085222603 |
| NPI Enumeration Date: | 08/28/2015 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |