Basic Information
| Provider Information | |||||||||
| NPI: | 1629384102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEELER | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 216 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705266577 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 216 N 3RD ST | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807514302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705266577 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101Y00000X | A1007077 | AR | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | LPC.0011683 | CO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.