Provider Demographics
NPI:1740343292
Name:WHEELER, DANETRA LA'VETTE
Entity type:Individual
Prefix:MRS
First Name:DANETRA
Middle Name:LA'VETTE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S. FARRELL DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-416-1360
Mailing Address - Fax:760-416-1362
Practice Address - Street 1:333 S. FARRELL DRIVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-416-1360
Practice Address - Fax:760-416-1362
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist