Provider Demographics
NPI:1316965171
Name:WHEELER, CHARLENE C (LPC)
Entity type:Individual
Prefix:MS
First Name:CHARLENE
Middle Name:C
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CHAR
Other - Middle Name:C
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:3466 BRIDGELAND
Mailing Address - Street 2:#202
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-298-3937
Mailing Address - Fax:314-298-3913
Practice Address - Street 1:3466 BRIDGELAND
Practice Address - Street 2:#202
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-298-3937
Practice Address - Fax:314-298-3913
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001029282101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor