Provider Demographics
NPI:1205425360
Name:WEBER, JOHN MICHAEL (MA, LCDC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:WEBER
Suffix:
Gender:M
Credentials:MA, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 NASA PKWY APT 1015
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3242
Mailing Address - Country:US
Mailing Address - Phone:346-287-2740
Mailing Address - Fax:
Practice Address - Street 1:2727 NASA PKWY APT 1015
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3242
Practice Address - Country:US
Practice Address - Phone:346-287-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14639101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)