Provider Demographics
NPI:1740881275
Name:WEBER, COREY D (LCDC)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:D
Last Name:WEBER
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COREY.WEBER@WARRIORSHEART.COM
Mailing Address - Street 2:198 COUNTY ROAD 2733
Mailing Address - City:MICO
Mailing Address - State:TX
Mailing Address - Zip Code:78056
Mailing Address - Country:US
Mailing Address - Phone:309-781-7519
Mailing Address - Fax:
Practice Address - Street 1:756 PURPLE SAGE RD
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003-3981
Practice Address - Country:US
Practice Address - Phone:309-781-7519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11601101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
11601OtherRTC