Healthcare Provider Details

I. General information

NPI: 1902724982
Provider Name (Legal Business Name): MICAH JAMES WHELAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 WILLOWBANK ST
BELLEFONTE PA
16823-1327
US

IV. Provider business mailing address

3771 WARRIORS MARK PATH
WARRIORS MARK PA
16877-6370
US

V. Phone/Fax

Practice location:
  • Phone: 814-699-1058
  • Fax:
Mailing address:
  • Phone: 814-699-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMF000112
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: