Individual
MARK D WIESNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
8100 W MAIN ST, BELLEVILLE, IL 62223-2018
(618) 397-1407
Mailing address
1567 SINKING SPRINGS DR, O FALLON, IL 62269-6658
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
166.000546
IL
Other
Enumeration date
09/20/2019
Last updated
09/20/2019
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