Provider Demographics
NPI:1265107650
Name:WEBER, PATRICIA LEA (LPCC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEA
Last Name:WEBER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 AGNES ST STE 112-613
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-2156
Mailing Address - Country:US
Mailing Address - Phone:952-210-6285
Mailing Address - Fax:
Practice Address - Street 1:173 CASSEL WAY
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5727
Practice Address - Country:US
Practice Address - Phone:952-210-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88472101YP2500X
MN2940101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional