=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609901073
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH WAIBEL, LPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 04/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 AIRPORT FWY STE 6
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-5358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-454-0011
-----------------------------------------------------
Fax | 817-282-3929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 AIRPORT FWY STE 6
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76021-5358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-454-0011
-----------------------------------------------------
Fax | 817-282-3929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | MR. JOSEPH HENRY WAIBEL V
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 817-454-0011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 15568
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------