Provider Demographics
NPI:1205980588
Name:WHEATLEY, JEFFREY ALAN (LCSW)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
Last Name:WHEATLEY
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 1:11955 N METEOR PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-3468
Mailing Address - Country:US
Mailing Address - Phone:520-403-6001
Mailing Address - Fax:520-797-1402
Practice Address - Street 1:2524 W RUTHRAUFF
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705
Practice Address - Country:US
Practice Address - Phone:520-403-6001
Practice Address - Fax:520-797-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-13281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical