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General NPI Number Information
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NPI Number | 1821398108
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Entity Type | Organization
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Legal Business Name | JUDY KAYE WIEBERG
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 2105 CAPURRO WAY SUITE 105
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City | SPARKS
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State | NV
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Zip | 89431-8518
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Country | US
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Telephone | 775-848-7674
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Fax |
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Provider Business Mailing Address
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Address Line | 11040 HEARTPINE ST
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City | RENO
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State | NV
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Zip | 89506-8952
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Country | US
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Telephone | 775-848-7674
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | JUDY KAYE WIEBERG
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Credential | LCPC
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Telephone | 775-848-7674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1089-L
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | CPOO21
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License Number State | NV
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