Provider Demographics
NPI:1851528012
Name:WHEELER, KURT MICHAEL (LPC)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:MICHAEL
Last Name:WHEELER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 N OTSEGO AVE
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-1531
Mailing Address - Country:US
Mailing Address - Phone:989-732-4550
Mailing Address - Fax:989-732-2551
Practice Address - Street 1:651 N OTSEGO AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1531
Practice Address - Country:US
Practice Address - Phone:989-732-4550
Practice Address - Fax:989-732-2551
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004268101YP2500X
MI6301007205103TC1900X
MI6801063013104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No104100000XBehavioral Health & Social Service ProvidersSocial Worker