Healthcare Provider Details

I. General information

NPI: 1063625531
Provider Name (Legal Business Name): KAREN DIANE WHEELER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NORTHWEST BLVD STE 6
COEUR D ALENE ID
83814-2974
US

IV. Provider business mailing address

803 ELM AVENUE
COEUR D'ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-818-3738
  • Fax:
Mailing address:
  • Phone: 208-818-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 73
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: