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NPI Code Detail

MEDICARE: PETER L WIETHE MA, LMHC

MEDICARE: PETER L WIETHE MA, LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist39001550AIN
2101YM0800XMental Health Counselor39001550AIN

General Provider Information

NPI Number : 1831162486
Entity Type Code : Individual
Provider Name (Legal Business Name) : PETER L WIETHE MA, LMHC
Provider Business Mailing Address
First Line : 3403 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-957-2000
Fax Number :
Provider Business Practice Location Address
First Line : 1522 W MORRIS ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46221-1629
Country : US
Telephone Number : 317-957-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2006
Last Update Date : 06/04/2024

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Directions to “ PETER L WIETHE MA, LMHC” Practice Location

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