Provider Demographics
NPI:1295943611
Name:WHEELER, GUY A (DOCTOR OF DIVINITY)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DOCTOR OF DIVINITY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 W BROWARD BLVD
Mailing Address - Street 2:STE R
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-3775
Mailing Address - Country:US
Mailing Address - Phone:954-797-1617
Mailing Address - Fax:954-797-1618
Practice Address - Street 1:4330 W BROWARD BLVD
Practice Address - Street 2:SUITE R
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3775
Practice Address - Country:US
Practice Address - Phone:954-797-1617
Practice Address - Fax:954-797-1617
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 251B00000X, 251S00000X
FL101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health