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General NPI Number Information
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NPI Number | 1649222555
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Entity Type | Individual
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Provider Name | SAMANTHA LORINE WHEELER PH.D., LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 694 W. CHICAGO STREET
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City | COLDWATER
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State | MI
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Zip | 49068
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Country | US
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Telephone | 517-279-8866
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Fax | 517-279-8866
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Provider Business Mailing Address
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Address Line | 694 W. CHICAGO STREET
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City | COLDWATER
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State | MI
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Zip | 49068
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Country | US
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Telephone | 517-279-8866
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Fax | 517-279-8866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301015601
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008438
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801084214
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.014758
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License Number State | IL
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