MEDICARE: GENESIS A WHEELER LMHCA

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	101YM0800X	Mental Health Counselor	MC61526722	WA

General Provider Information

NPI Number	:	1932725983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENESIS A WHEELER LMHCA

Provider Business Mailing Address
First Line	:	1721 HEWITT AVE # 317
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98201-3570
Country	:	US
Telephone Number	:	425-231-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 N OLYMPIC AVE STE 234
Second Line	:
City	:	ARLINGTON
State	:	WA
Zip	:	98223-1322
Country	:	US
Telephone Number	:	360-363-4234
Fax Number	:

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

Provider Enumeration Date	:	06/24/2020
Last Update Date	:	04/13/2025

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