Provider Demographics
NPI:1770923757
Name:WEBER, IZABELA (LCPC, NCC)
Entity type:Individual
Prefix:
First Name:IZABELA
Middle Name:
Last Name:WEBER
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:IZABELA
Other - Middle Name:
Other - Last Name:WODZINSKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, NCC
Mailing Address - Street 1:15613 E PALOMINO BLVD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-4823
Mailing Address - Country:US
Mailing Address - Phone:480-434-3418
Mailing Address - Fax:928-433-8034
Practice Address - Street 1:15613 E PALOMINO BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-4823
Practice Address - Country:US
Practice Address - Phone:480-434-3418
Practice Address - Fax:928-433-8034
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010104101YP2500X
AZ18116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional