Basic Information
| Provider Information | |||||||||
| NPI: | 1487893327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WECK | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WECK | ||||||||
| OtherFirstName: | PANDY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 29748 RANCHO CALIFORNIA RD | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925915286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516940695 | ||||||||
| FaxNumber: | 9516956215 | ||||||||
| Practice Location | |||||||||
| Address1: | 29748 RANCHO CALIFORNIA RD | ||||||||
| Address2: | |||||||||
| City: | TEMECULA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925915286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516940695 | ||||||||
| FaxNumber: | 9516956215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2009 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC 50530 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.