Provider Demographics
NPI:1760140891
Name:WHEELER, ALLE-MAZ
Entity type:Individual
Prefix:
First Name:ALLE-MAZ
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7830 HIGHWAY 72 W STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9502
Mailing Address - Country:US
Mailing Address - Phone:518-992-6506
Mailing Address - Fax:
Practice Address - Street 1:7830 HIGHWAY 72 W STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9502
Practice Address - Country:US
Practice Address - Phone:518-992-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-06
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YM0800X
NY013746-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health