Provider Demographics
NPI:1821398108
Name:JUDY KAYE WIEBERG
Entity Type:Organization
Organization Name:JUDY KAYE WIEBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:WIEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:775-848-7674
Mailing Address - Street 1:11040 HEARTPINE ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-8952
Mailing Address - Country:US
Mailing Address - Phone:775-848-7674
Mailing Address - Fax:
Practice Address - Street 1:2105 CAPURRO WAY
Practice Address - Street 2:SUITE 105
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8518
Practice Address - Country:US
Practice Address - Phone:775-848-7674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCPOO21101Y00000X
NV1089-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty