=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770251613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WHEEL COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2021
-----------------------------------------------------
Last Update Date | 10/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 MORNINGSIDE DR STE A
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-2600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-733-0153
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 605 W BELMAR ST
-----------------------------------------------------
City | LAKELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33803-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-508-0468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | LIZ HALL
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 407-508-0468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------