Provider Demographics
NPI:1073641965
Name:WHEELER, KERRIE K (LCPC)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:K
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 GALLATIN AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3014
Mailing Address - Country:US
Mailing Address - Phone:406-449-7162
Mailing Address - Fax:406-442-6809
Practice Address - Street 1:1503 GALLATIN AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3014
Practice Address - Country:US
Practice Address - Phone:406-449-7162
Practice Address - Fax:406-442-6809
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT522970Medicaid
MT741490OtherBLUECROSS BLUESHIELD