Healthcare Provider Details

I. General information

NPI: 1932946167
Provider Name (Legal Business Name): WEIDENBENNER COUNSELING & CONSULTING SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 5TH AVE
INDIALANTIC FL
32903-4280
US

IV. Provider business mailing address

724 CORBIN CIR SW
PALM BAY FL
32908-8175
US

V. Phone/Fax

Practice location:
  • Phone: 321-722-7604
  • Fax:
Mailing address:
  • Phone: 608-370-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH WEIDENBENNER
Title or Position: OWNER/DIRECTOR
Credential: LPC
Phone: 608-370-4169