1740343078 NPI number — MS. MARY K. WEITZ M.S., L.P.C.

Table of content: MS. MARY K. WEITZ M.S., L.P.C. (NPI 1740343078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740343078 NPI number — MS. MARY K. WEITZ M.S., L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEITZ
Provider First Name:
MARY
Provider Middle Name:
K.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.P.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEITZ
Provider Other First Name:
SABIHA
Provider Other Middle Name:
MARY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., L.P.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1740343078
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 E 6TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76513-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-215-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4802 S 31ST ST
Provider Second Line Business Practice Location Address:
APT. # 911
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76502-6208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-721-5338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2006

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: 101YP2500X , with the licence number:  2763 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0955080 SFX 01-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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