Basic Information
| Provider Information | |||||||||
| NPI: | 1730395013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHEAT | ||||||||
| FirstName: | EVELYN | ||||||||
| MiddleName: | ROXANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1270 DORIS RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483262617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482768000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1270 DORIS RD | ||||||||
| Address2: | |||||||||
| City: | AUBURN HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483262617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482768000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 04/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301003396 | MI | N | Behavioral Health & Social Service Providers | Psychologist | 103TB0200X | 6301003396 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TM1800X | 6301003396 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities |
No ID Information.