Provider Demographics
NPI:1740301860
Name:WHEELER, RAYMOND MICHAEL (LPC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
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 1:5252 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6036
Mailing Address - Country:US
Mailing Address - Phone:214-392-4945
Mailing Address - Fax:214-432-7518
Practice Address - Street 1:3402 OAK GROVE AVE
Practice Address - Street 2:#300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2353
Practice Address - Country:US
Practice Address - Phone:214-392-4945
Practice Address - Fax:214-432-7518
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional