Healthcare Provider Details

I. General information

NPI: 1295034247
Provider Name (Legal Business Name): LAURA MARIE WHEELER PCC, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 E MAIN ST
WAKEMAN OH
44889
US

IV. Provider business mailing address

59 E MAIN ST
WAKEMAN OH
44889-9299
US

V. Phone/Fax

Practice location:
  • Phone: 440-839-2200
  • Fax: 888-408-7306
Mailing address:
  • Phone: 440-839-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberM.0900029
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0900021
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: