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General NPI Number Information
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NPI Number | 1740343078
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Entity Type | Individual
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Provider Name | MARY K. WEITZ M.S., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 4802 S 31ST ST APT. # 911
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City | TEMPLE
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State | TX
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Zip | 76502-6208
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Country | US
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Telephone | 254-721-5338
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Fax |
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Provider Business Mailing Address
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Address Line | 615 E 6TH AVE
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City | BELTON
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State | TX
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Zip | 76513-2707
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Country | US
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Telephone | 254-215-2000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2763
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License Number State | TX
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