Provider Demographics
NPI:1023279874
Name:WHEAT, PATRICIA D (MS BCBA, CMHP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:WHEAT
Suffix:
Gender:F
Credentials:MS BCBA, CMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5165 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8902
Mailing Address - Country:US
Mailing Address - Phone:850-492-2645
Mailing Address - Fax:
Practice Address - Street 1:5165 ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32507-8902
Practice Address - Country:US
Practice Address - Phone:850-492-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50706101YM0800X
FL1-01-0537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherTRICARE SOUTH REGION