Provider Demographics
NPI:1487280319
Name:PRIESMEYER, WENDI NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:WENDI
Middle Name:NICOLE
Last Name:PRIESMEYER
Suffix:
Gender:F
Credentials:LCSW
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 334
Mailing Address - Street 2:
Mailing Address - City:LOUISE
Mailing Address - State:TX
Mailing Address - Zip Code:77455-0334
Mailing Address - Country:US
Mailing Address - Phone:979-257-7869
Mailing Address - Fax:361-782-7865
Practice Address - Street 1:1013 S WELLS ST
Practice Address - Street 2:
Practice Address - City:EDNA
Practice Address - State:TX
Practice Address - Zip Code:77957-4045
Practice Address - Country:US
Practice Address - Phone:979-257-7869
Practice Address - Fax:361-782-7865
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical