Provider Demographics
NPI:1023025970
Name:WEBER, MARY THERESE (PMHNP-BC, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESE
Last Name:WEBER
Suffix:
Gender:F
Credentials:PMHNP-BC, PHD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13120 EAST 19TH AVE, MAIL STOP C288-18
Mailing Address - Street 2:UNIVERSITY OF COLORADO COLLEGE OF NURSING
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045
Mailing Address - Country:US
Mailing Address - Phone:303-724-2949
Mailing Address - Fax:303-724-8560
Practice Address - Street 1:8801 LIPAN ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-4912
Practice Address - Country:US
Practice Address - Phone:303-720-9085
Practice Address - Fax:303-657-3227
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX655931363LP0808X
CO182710363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1551277-01Medicaid
TX8N3334OtherBCBS
TX1551277-01Medicaid
TX8N3334OtherBCBS