MEDICARE: MR. MICHAEL EDWARD WHEATON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT1212	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417384587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL EDWARD WHEATON LMFT

Provider Business Mailing Address
First Line	:	2525 W MAIN ST STE 214
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2439
Country	:	US
Telephone Number	:	605-988-8122
Fax Number	:	605-988-8141

Provider Business Practice Location Address
First Line	:	2525 W MAIN ST STE 214
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-2439
Country	:	US
Telephone Number	:	605-988-8122
Fax Number	:	605-988-8141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2013
Last Update Date	:	04/12/2021

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