Provider Demographics
NPI:1063945970
Name:WHEATLEY, JACOB AARON (PHD, LPC, CCLS, NCC)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:AARON
Last Name:WHEATLEY
Suffix:
Gender:M
Credentials:PHD, LPC, CCLS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 OLD POND RD STE 706B
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-3415
Mailing Address - Country:US
Mailing Address - Phone:412-695-3232
Mailing Address - Fax:
Practice Address - Street 1:800 OLD POND RD STE 706B
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-3415
Practice Address - Country:US
Practice Address - Phone:412-695-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional