Provider Demographics
NPI:1215028386
Name:WECKEL, GEOFFREY W (LPC)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:W
Last Name:WECKEL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BAILEY AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2119
Mailing Address - Country:US
Mailing Address - Phone:682-472-4925
Mailing Address - Fax:
Practice Address - Street 1:550 BAILEY AVE STE 302
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2119
Practice Address - Country:US
Practice Address - Phone:682-472-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17309101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional