Provider Demographics
NPI:1003095779
Name:PAUL WEISEMANN PROFESSIONAL CHRISTIAN COUNSELING LLC
Entity Type:Organization
Organization Name:PAUL WEISEMANN PROFESSIONAL CHRISTIAN COUNSELING LLC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEISEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMHC
Authorized Official - Phone:813-643-2600
Mailing Address - Street 1:138 E BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8101
Mailing Address - Country:US
Mailing Address - Phone:813-643-2600
Mailing Address - Fax:813-643-2600
Practice Address - Street 1:138 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8101
Practice Address - Country:US
Practice Address - Phone:813-643-2600
Practice Address - Fax:813-643-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty