Provider Demographics
NPI:1003544529
Name:WHEELER, JILL (LMFT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 NW BRICKYARD ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-7020
Mailing Address - Country:US
Mailing Address - Phone:541-241-0741
Mailing Address - Fax:
Practice Address - Street 1:745 NW MT WASHINGTON DR STE 307
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-1576
Practice Address - Country:US
Practice Address - Phone:541-241-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT2141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist