Provider Demographics
NPI:1902681687
Name:WHEELER, NICOLE (LPC-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7010 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5713
Mailing Address - Country:US
Mailing Address - Phone:918-492-2554
Mailing Address - Fax:
Practice Address - Street 1:9912 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1620
Practice Address - Country:US
Practice Address - Phone:918-779-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11242101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional