=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417353012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE DEANNE WHEELER LPC, LCDC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2014
-----------------------------------------------------
Last Update Date | 07/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 AIRPORT RD
-----------------------------------------------------
City | TERRELL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75160-4302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-524-4159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10502 OAK CREEK DR.
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-456-4313
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 73156
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------