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NPI Code Detail

MEDICARE: EMILY ROSE WHEELOCK LCDC

MEDICARE: EMILY ROSE WHEELOCK LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor17335TX

General Provider Information

NPI Number : 1801689328
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY ROSE WHEELOCK LCDC
Provider Business Mailing Address
First Line : 8300 SKILLMAN ST APT 105
Second Line :
City : DALLAS
State : TX
Zip : 75231-2008
Country : US
Telephone Number : 585-705-2190
Fax Number :
Provider Business Practice Location Address
First Line : 4701 SAMUELL BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75228-6828
Country : US
Telephone Number : 972-861-5611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2025
Last Update Date : 12/08/2025

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Directions to “ EMILY ROSE WHEELOCK LCDC” Practice Location

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