Healthcare Provider Details

I. General information

NPI: 1104207018
Provider Name (Legal Business Name): MARY WEBER LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 N DULUTH AVE
SIOUX FALLS SD
57104-2714
US

IV. Provider business mailing address

1500 S SYCAMORE AVE SUITE 102
SIOUX FALLS SD
57110-3708
US

V. Phone/Fax

Practice location:
  • Phone: 605-988-3775
  • Fax:
Mailing address:
  • Phone: 605-201-1828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC667
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT1173
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: