Healthcare Provider Details

I. General information

NPI: 1366196586
Provider Name (Legal Business Name): STEPHEN C. WHEELER LPC, CTRS, SCL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N MAIN ST
LAKE CITY MI
49651-5103
US

IV. Provider business mailing address

310 N FRONT
LAKE CITY MI
49651-9307
US

V. Phone/Fax

Practice location:
  • Phone: 231-295-1196
  • Fax:
Mailing address:
  • Phone: 616-433-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401223384
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401223384
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: