Healthcare Provider Details

I. General information

NPI: 1679762637
Provider Name (Legal Business Name): SUSAN D. WEIMER L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2214 EMERY ST STE 510
DENTON TX
76201-2476
US

IV. Provider business mailing address

412 MADISON PL
PONDER TX
76259-8469
US

V. Phone/Fax

Practice location:
  • Phone: 940-291-3641
  • Fax: 940-808-1018
Mailing address:
  • Phone: 817-938-3998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18514
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: