Provider Demographics
NPI:1528363660
Name:WEBER, THERESA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:WEBER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 E. WOOSTER STREET, BOX 24
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-3466
Mailing Address - Country:US
Mailing Address - Phone:419-352-4624
Mailing Address - Fax:
Practice Address - Street 1:1616 E. WOOSTER STREET
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-3466
Practice Address - Country:US
Practice Address - Phone:419-352-4624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1000265101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor