Provider Demographics
NPI:1609041920
Name:CHARLES WHEATON PHD PA
Entity Type:Organization
Organization Name:CHARLES WHEATON PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:727-535-0468
Mailing Address - Street 1:2240 BELLEAIR ROAD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-1706
Mailing Address - Country:US
Mailing Address - Phone:727-535-0468
Mailing Address - Fax:727-535-2588
Practice Address - Street 1:2240 BELLEAIR ROAD
Practice Address - Street 2:SUITE 170
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-1706
Practice Address - Country:US
Practice Address - Phone:727-535-0468
Practice Address - Fax:727-535-2588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty