Provider Demographics
NPI:1053436097
Name:WHEELER, MARY ELIZABETH (MS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:WHEELER
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 1:2727 WALSH AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-0956
Mailing Address - Country:US
Mailing Address - Phone:408-727-1235
Mailing Address - Fax:
Practice Address - Street 1:2727 WALSH AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-0956
Practice Address - Country:US
Practice Address - Phone:408-727-1235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19236101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional