Provider Demographics
NPI:1861488744
Name:WEISS, GLORIA K (LCPC)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:K
Last Name:WEISS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:K
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:105 S. MAIN STREET
Mailing Address - City:JOLIET
Mailing Address - State:MT
Mailing Address - Zip Code:59041-0238
Mailing Address - Country:US
Mailing Address - Phone:406-962-9888
Mailing Address - Fax:406-962-9888
Practice Address - Street 1:105 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:MT
Practice Address - Zip Code:59041-0238
Practice Address - Country:US
Practice Address - Phone:406-962-9888
Practice Address - Fax:406-962-9888
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT743LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional