1255476156 NPI number — VALERIE WEBER MA, LMHC

Table of content: VALERIE WEBER MA, LMHC (NPI 1255476156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255476156 NPI number — VALERIE WEBER MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBER
Provider First Name:
VALERIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255476156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
804 MONROE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PORTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46350-3511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-229-0109
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 MONROE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PORTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46350-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-229-0109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  39001617A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121577 . This is a "VALUE OPTIONS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200811120A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22000000362356 . This is a "ANTHEM BLUE CROSS AND BLU" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 794834000 . This is a "MEGELLAN HEALTH SERVICES" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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