Healthcare Provider Details

I. General information

NPI: 1932872272
Provider Name (Legal Business Name): PATRICK ALLEN WHEELER I M.ED., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 STRATFORD AVE
SAINT LOUIS MO
63120-1328
US

IV. Provider business mailing address

6510 STRATFORD AVE
SAINT LOUIS MO
63120-1328
US

V. Phone/Fax

Practice location:
  • Phone: 314-225-9771
  • Fax:
Mailing address:
  • Phone: 314-225-9771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2019014715
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: