Provider Demographics
NPI:1801192026
Name:WETZEL THERAPY INC
Entity Type:Organization
Organization Name:WETZEL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:WETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-243-7730
Mailing Address - Street 1:17903 STATE ROAD 23
Mailing Address - Street 2:SUITE #3
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1642
Mailing Address - Country:US
Mailing Address - Phone:574-243-7730
Mailing Address - Fax:574-243-7735
Practice Address - Street 1:17903 STATE ROAD 23
Practice Address - Street 2:SUITE #3
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1642
Practice Address - Country:US
Practice Address - Phone:574-243-7730
Practice Address - Fax:574-243-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-05
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001342A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty