| NPI | 1043661135 |
|---|---|
| Former Name | KEVIN NATHANIEL PHELPS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: P1906080) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AR P1906080) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2024-04-24 |