Basic Information
| Provider Information | |||||||||
| NPI: | 1386078160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | LA.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6331 W 110TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136961911 | ||||||||
| FaxNumber: | 9136961619 | ||||||||
| Practice Location | |||||||||
| Address1: | 6331 W 110TH ST | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136961911 | ||||||||
| FaxNumber: | 9136961619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2013 | ||||||||
| LastUpdateDate: | 08/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 202 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.