Provider Demographics
NPI:1144517657
Name:WHEELER, TONYA DAVON (CAC III)
Entity type:Individual
Prefix:MS
First Name:TONYA
Middle Name:DAVON
Last Name:WHEELER
Suffix:
Gender:F
Credentials:CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460176
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-0176
Mailing Address - Country:US
Mailing Address - Phone:720-435-0686
Mailing Address - Fax:303-295-1089
Practice Address - Street 1:1410 GRANT ST
Practice Address - Street 2:STE. B-305
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1844
Practice Address - Country:US
Practice Address - Phone:720-435-0686
Practice Address - Fax:303-295-1089
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5323101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)