Healthcare Provider Details

I. General information

NPI: 1003442674
Provider Name (Legal Business Name): TRACEY LYNN WHEELER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 W MAIN ST STE 3
GAYLORD MI
49735-1998
US

IV. Provider business mailing address

PO BOX 189
MANCELONA MI
49659-0189
US

V. Phone/Fax

Practice location:
  • Phone: 989-732-6761
  • Fax:
Mailing address:
  • Phone: 989-387-1734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801117027
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: