Provider Demographics
NPI:1043529183
Name:WIESNER, VICTOR VAN III (LPC, NCC, CCMHC, MBA)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:VAN
Last Name:WIESNER
Suffix:III
Gender:M
Credentials:LPC, NCC, CCMHC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 MARY KATHERYNS XING
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4979
Mailing Address - Country:US
Mailing Address - Phone:281-825-7789
Mailing Address - Fax:832-631-6281
Practice Address - Street 1:9595 SIX PINES DR
Practice Address - Street 2:SUITE 8210
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1531
Practice Address - Country:US
Practice Address - Phone:281-825-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14557101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional