Provider Demographics
NPI:1144539834
Name:WHEATLEY, MELISSA KAYE (MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:WHEATLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 S FLOYD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3828
Mailing Address - Country:US
Mailing Address - Phone:502-852-7897
Mailing Address - Fax:502-852-2911
Practice Address - Street 1:571 S FLOYD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3828
Practice Address - Country:US
Practice Address - Phone:502-852-7897
Practice Address - Fax:502-852-2911
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2010-71103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical