Provider Demographics
NPI:1912560582
Name:WEBER, JOHN RALPH JR (LPC, CRAADC, CRC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RALPH
Last Name:WEBER
Suffix:JR
Gender:M
Credentials:LPC, CRAADC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170A E GANNON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2636
Mailing Address - Country:US
Mailing Address - Phone:636-322-2225
Mailing Address - Fax:
Practice Address - Street 1:1170A E GANNON DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2636
Practice Address - Country:US
Practice Address - Phone:636-322-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor