Provider Demographics
NPI:1295001121
Name:WARD, BREAH WHEELER (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:BREAH
Middle Name:WHEELER
Last Name:WARD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COUNTY ROAD 94A
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-4154
Mailing Address - Country:US
Mailing Address - Phone:573-631-5158
Mailing Address - Fax:573-756-5579
Practice Address - Street 1:608 PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3020
Practice Address - Country:US
Practice Address - Phone:573-756-6674
Practice Address - Fax:573-756-5579
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012008189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional