Provider Demographics
NPI:1952022436
Name:WHEATON, CAYLA J
Entity type:Individual
Prefix:
First Name:CAYLA
Middle Name:J
Last Name:WHEATON
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:PO BOX 553
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358-0553
Mailing Address - Country:US
Mailing Address - Phone:936-524-3156
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 553
Practice Address - Street 2:
Practice Address - City:NEW WAVERLY
Practice Address - State:TX
Practice Address - Zip Code:77358-0553
Practice Address - Country:US
Practice Address - Phone:936-524-3156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108631104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker