MEDICARE: RICHARD CARROLL WHEAT MS, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	2020011371	OK
2	101YP2500X	Professional Counselor	74898	TX

General Provider Information

NPI Number	:	1386291425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CARROLL WHEAT MS, LPC, NCC

Provider Business Mailing Address
First Line	:	5536 E 106TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-7089
Country	:	US
Telephone Number	:	936-662-8580
Fax Number	:

Provider Business Practice Location Address
First Line	:	5536 E 106TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74137-7089
Country	:	US
Telephone Number	:	936-662-8580
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	06/28/2020

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