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General NPI Number Information
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NPI Number | 1881159986
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Entity Type | Individual
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Provider Name | ELIZA MAY MARIE WEITBRECHT PHD
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Gender | Female
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 05/25/2022
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Provider Practice Location Address
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Address Line | 3230 E WOODMEN RD STE 110
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-8502
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Country | US
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Telephone | 765-437-9849
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Fax |
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Provider Business Mailing Address
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Address Line | 642 JOHANNE PL APT A
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-6457
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Country | US
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Telephone | 765-437-9849
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 30715
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License Number State | CA
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