Provider Demographics
NPI:1275877045
Name:WHEELER, MELANI M (LPC, PHD)
Entity Type:Individual
Prefix:
First Name:MELANI
Middle Name:M
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2823 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-3437
Mailing Address - Country:US
Mailing Address - Phone:318-455-6122
Mailing Address - Fax:
Practice Address - Street 1:3776 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2132
Practice Address - Country:US
Practice Address - Phone:318-670-3159
Practice Address - Fax:318-754-4766
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional