Provider Demographics
NPI:1619445699
Name:WHEELER, JOHN RAY (LPCC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAY
Last Name:WHEELER
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W 1ST ST STE 308
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1150
Mailing Address - Country:US
Mailing Address - Phone:937-319-4448
Mailing Address - Fax:855-978-1771
Practice Address - Street 1:118 W 1ST ST STE 308
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1150
Practice Address - Country:US
Practice Address - Phone:937-319-4448
Practice Address - Fax:855-978-1771
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1901918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330742Medicaid