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General NPI Number Information
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NPI Number | 1861934929
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Entity Type | Individual
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Provider Name | SCOTT WHEELER
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Gender | Male
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Dates
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Enumeration Date | 11/07/2016
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 600 N THACKER AVE # ARED63
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City | KISSIMMEE
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State | FL
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Zip | 34741-4892
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Country | US
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Telephone | 407-994-2819
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N THACKER AVE # ARED63
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City | KISSIMMEE
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State | FL
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Zip | 34741-4892
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Country | US
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Telephone | 407-994-2819
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH-15051
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License Number State | FL
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