Provider Demographics
NPI:1568899854
Name:WIEDOWER, LIDIA ELYSE (RN BSN MS LPC)
Entity Type:Individual
Prefix:
First Name:LIDIA
Middle Name:ELYSE
Last Name:WIEDOWER
Suffix:
Gender:F
Credentials:RN BSN MS LPC
Other - Prefix:
Other - First Name:LIDIA
Other - Middle Name:ELYSE
Other - Last Name:STOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN BSN MS LPC
Mailing Address - Street 1:400 MANN ST
Mailing Address - Street 2:STE. 800
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-2046
Mailing Address - Country:US
Mailing Address - Phone:361-814-2001
Mailing Address - Fax:361-814-6502
Practice Address - Street 1:400 MANN ST
Practice Address - Street 2:STE. 800
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-2046
Practice Address - Country:US
Practice Address - Phone:361-814-2001
Practice Address - Fax:361-814-6502
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional