Provider Demographics
NPI:1982347837
Name:WHEATON HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:WHEATON HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:WHEATON
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW-S
Authorized Official - Phone:254-228-5646
Mailing Address - Street 1:1 E CENTRAL AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-7625
Mailing Address - Country:US
Mailing Address - Phone:254-228-5646
Mailing Address - Fax:
Practice Address - Street 1:1 E CENTRAL AVE STE 207
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7625
Practice Address - Country:US
Practice Address - Phone:254-228-5646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)