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General NPI Number Information
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NPI Number | 1831734672
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Entity Type | Individual
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Provider Name | JAY CHARLES WHEELER
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Gender | Male
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 307 S CENTRAL AVE
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City | LOS ANGELES
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State | CA
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Zip | 90013-1709
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Country | US
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Telephone | 323-541-6176
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Fax |
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Provider Business Mailing Address
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Address Line | 8149 SANTA MONICA BLVD # 433
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-4912
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Country | US
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Telephone | 323-541-6176
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13418-R
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License Number State | CA
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