Provider Demographics
NPI:1427414853
Name:WHEELER, KIMBERLY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 E MIRROR LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:KAMAS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-5532
Mailing Address - Country:US
Mailing Address - Phone:801-644-5440
Mailing Address - Fax:
Practice Address - Street 1:135 S MAIN ST
Practice Address - Street 2:STE 211
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-2047
Practice Address - Country:US
Practice Address - Phone:435-657-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7471286-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical