Provider Demographics
NPI:1902111925
Name:WHEELER, JILL LENEIGH (LPC-S, LMFT, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:LENEIGH
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPC-S, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23010 GABRIEL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW CANEY
Mailing Address - State:TX
Mailing Address - Zip Code:77357-4153
Mailing Address - Country:US
Mailing Address - Phone:281-928-6581
Mailing Address - Fax:
Practice Address - Street 1:23010 GABRIEL
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-4153
Practice Address - Country:US
Practice Address - Phone:281-928-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65211101YP2500X
MO2012040531101YP2500X
TX201494106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX335434203Medicaid