Provider Demographics
NPI:1194254169
Name:WEISENBORN, GLORIA STEPHANIE (LMFT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:STEPHANIE
Last Name:WEISENBORN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 W WALNUT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6233
Mailing Address - Country:US
Mailing Address - Phone:559-627-1490
Mailing Address - Fax:
Practice Address - Street 1:1750 W WALNUT AVE STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6233
Practice Address - Country:US
Practice Address - Phone:559-627-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121596106H00000X
CA99890101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health