MEDICARE: DANA MARIE WEACHTER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC004565	PA

General Provider Information

NPI Number	:	1063816387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA MARIE WEACHTER LPC

Provider Business Mailing Address
First Line	:	77 LOGGERS MILL RD
Second Line	:
City	:	HORSHAM
State	:	PA
Zip	:	19044-1924
Country	:	US
Telephone Number	:	215-868-6988
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 PENNSYLVANIA AVE
Second Line	:	SUITE 101
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3410
Country	:	US
Telephone Number	:	215-868-6988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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