Provider Demographics
NPI:1205912680
Name:WEDELL, ELIZABETH FAYE (LPC; LMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAYE
Last Name:WEDELL
Suffix:
Gender:F
Credentials:LPC; LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 812
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-0812
Mailing Address - Country:US
Mailing Address - Phone:903-583-2661
Mailing Address - Fax:903-583-2661
Practice Address - Street 1:112 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4365
Practice Address - Country:US
Practice Address - Phone:903-640-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11414101YP2500X
TX101YS0200X
TX004152106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist