Provider Demographics
NPI:1265477665
Name:WOLBRINK, MARK A (MS, LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:WOLBRINK
Suffix:
Gender:M
Credentials:MS, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 S STAPLES ST
Mailing Address - Street 2:SUITE S-203
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5201
Mailing Address - Country:US
Mailing Address - Phone:361-852-9665
Mailing Address - Fax:361-852-2794
Practice Address - Street 1:3833 S STAPLES ST
Practice Address - Street 2:SUITE S-203
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5201
Practice Address - Country:US
Practice Address - Phone:361-852-9665
Practice Address - Fax:361-852-2794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10688101YM0800X
TX004000-124878106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80638LOtherBLUE CROSS/BLUE SHIELD