Provider Demographics
NPI:1124166533
Name:WIHEBRINK, JEFFREY LEE I (LMHC, MAC, SAP)
Entity type:Individual
Prefix:PROF
First Name:JEFFREY
Middle Name:LEE
Last Name:WIHEBRINK
Suffix:I
Gender:M
Credentials:LMHC, MAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6845
Mailing Address - Country:US
Mailing Address - Phone:260-432-9916
Mailing Address - Fax:260-960-9349
Practice Address - Street 1:4660 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6845
Practice Address - Country:US
Practice Address - Phone:260-432-9916
Practice Address - Fax:260-960-9349
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health