Provider Demographics
NPI:1093086704
Name:WEIBY, KATHLEEN TERESA (MASTERS IN COUNSELIN)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:TERESA
Last Name:WEIBY
Suffix:
Gender:F
Credentials:MASTERS IN COUNSELIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4140 E BASELINE ROAD
Mailing Address - Street 2:#101-315
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4412
Mailing Address - Country:US
Mailing Address - Phone:480-347-8136
Mailing Address - Fax:480-584-6111
Practice Address - Street 1:4140 E BASELINE ROAD
Practice Address - Street 2:#101-315
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4412
Practice Address - Country:US
Practice Address - Phone:480-347-8136
Practice Address - Fax:480-347-8136
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC#11970101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor