Provider Demographics
NPI:1417390055
Name:WIETOR, JOY BERNARD (LMFT LMHC)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:BERNARD
Last Name:WIETOR
Suffix:
Gender:F
Credentials:LMFT LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 E LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5416
Mailing Address - Country:US
Mailing Address - Phone:407-892-1791
Mailing Address - Fax:
Practice Address - Street 1:2001 HICKORY TREE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34772-8906
Practice Address - Country:US
Practice Address - Phone:407-460-7856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-13
Last Update Date:2013-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8245101YM0800X
FLMT2227106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health