Provider Demographics
NPI:1437045150
Name:DICKERSON, PHELAN EDAIN (LPC)
Entity type:Individual
Prefix:
First Name:PHELAN
Middle Name:EDAIN
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S LOCUST ST APT 201
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-6052
Mailing Address - Country:US
Mailing Address - Phone:512-547-9734
Mailing Address - Fax:
Practice Address - Street 1:4004 GATEWAY DR STE 180
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7911
Practice Address - Country:US
Practice Address - Phone:512-547-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89847101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty