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General NPI Number Information
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NPI Number | 1578498960
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Entity Type | Organization
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Legal Business Name | THERESA WISS, LCSW, LLC
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 7200 MANCHESTER RD
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City | MAPLEWOOD
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State | MO
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Zip | 63143-2403
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Country | US
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Telephone | 860-324-3581
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Fax |
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Provider Business Mailing Address
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Address Line | 6925 COLUMBIA AVE
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City | UNIVERSITY CITY
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State | MO
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Zip | 63130-3127
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Country | US
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Telephone | 860-324-3581
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Fax | 860-324-3581
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Authorized Official
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Title or Position | OWNER/LCSW
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Name | THERESA WISS
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Credential | LCSW
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Telephone | 860-324-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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