Provider Demographics
NPI:1750659561
Name:WHEELER, MICHAEL D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:WHEELER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 LANDMARK DR STE 370
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1354
Mailing Address - Country:US
Mailing Address - Phone:513-568-9070
Mailing Address - Fax:859-392-3966
Practice Address - Street 1:103 LANDMARK DR STE 370
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1354
Practice Address - Country:US
Practice Address - Phone:513-568-9070
Practice Address - Fax:859-392-3966
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0145531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical