Provider Demographics
NPI:1295006484
Name:WIEME, JAMES J (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:WIEME
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3765
Mailing Address - Country:US
Mailing Address - Phone:619-337-6100
Mailing Address - Fax:619-697-7027
Practice Address - Street 1:8585 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3765
Practice Address - Country:US
Practice Address - Phone:619-337-6100
Practice Address - Fax:619-697-7027
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist