Provider Demographics
NPI:1346512142
Name:WETZEL, MISTI DAWN (LMFT)
Entity type:Individual
Prefix:
First Name:MISTI
Middle Name:DAWN
Last Name:WETZEL
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 1:2027 S 61ST ST STE 112
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6857
Mailing Address - Country:US
Mailing Address - Phone:254-563-9228
Mailing Address - Fax:855-971-0138
Practice Address - Street 1:2027 S 61ST ST STE 112
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6857
Practice Address - Country:US
Practice Address - Phone:254-563-9228
Practice Address - Fax:855-971-0138
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201818101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health