Provider Demographics
NPI:1205623253
Name:WIEGAND, TOVA (LMHC)
Entity type:Individual
Prefix:
First Name:TOVA
Middle Name:
Last Name:WIEGAND
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:TOVA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:347 W BERRY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2216
Mailing Address - Country:US
Mailing Address - Phone:260-483-2400
Mailing Address - Fax:260-483-2400
Practice Address - Street 1:347 W BERRY ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-2216
Practice Address - Country:US
Practice Address - Phone:260-483-2400
Practice Address - Fax:260-483-2400
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39005406A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health