Provider Demographics
NPI:1336271824
Name:LINK, JOHN WHEATON (MS LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WHEATON
Last Name:LINK
Suffix:
Gender:M
Credentials:MS LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 LAKE AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5397
Mailing Address - Country:US
Mailing Address - Phone:260-438-9540
Mailing Address - Fax:
Practice Address - Street 1:2200 LAKE AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-5397
Practice Address - Country:US
Practice Address - Phone:260-438-9540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000358A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCAQH PROVIDEROther11506176
INLICENSE NUMBEROther35000358A