Provider Demographics
NPI:1114717402
Name:WHETZEL, JOSEPH DANIEL
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANIEL
Last Name:WHETZEL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 GLENMEADOW LN
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2226
Mailing Address - Country:US
Mailing Address - Phone:517-927-8462
Mailing Address - Fax:
Practice Address - Street 1:4902 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5474
Practice Address - Country:US
Practice Address - Phone:517-369-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)