Healthcare Provider Details

I. General information

NPI: 1720035645
Provider Name (Legal Business Name): DAVID LANSON WHEELER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 EZELL STREET
RUSTON LA
71270
US

IV. Provider business mailing address

901 S VIENNA ST
RUSTON LA
71270-5829
US

V. Phone/Fax

Practice location:
  • Phone: 318-251-3126
  • Fax:
Mailing address:
  • Phone: 318-255-5540
  • Fax: 318-255-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number790
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: