Provider Demographics
NPI:1831641240
Name:WEISENBURGER INC.
Entity Type:Organization
Organization Name:WEISENBURGER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISENBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:949-610-0858
Mailing Address - Street 1:232 W MAIN ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7712
Mailing Address - Country:US
Mailing Address - Phone:949-610-0858
Mailing Address - Fax:
Practice Address - Street 1:232 W MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7712
Practice Address - Country:US
Practice Address - Phone:949-610-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty