Provider Demographics
NPI:1316679400
Name:WHEELER, STEPHANIE MARCIA
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARCIA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11451 W MADISEN ELLISE DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-6964
Mailing Address - Country:US
Mailing Address - Phone:602-576-8744
Mailing Address - Fax:
Practice Address - Street 1:11451 W MADISEN ELLISE DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-6964
Practice Address - Country:US
Practice Address - Phone:602-576-8744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health