Healthcare Provider Details

I. General information

NPI: 1245897594
Provider Name (Legal Business Name): MARIA THERESE WEEKS MS, MA, LPC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W3243 SCHMITZ RD
MOUNT CALVARY WI
53057-9748
US

IV. Provider business mailing address

W3243 SCHMITZ RD
MOUNT CALVARY WI
53057-9748
US

V. Phone/Fax

Practice location:
  • Phone: 920-400-7324
  • Fax:
Mailing address:
  • Phone: 920-400-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4340226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: