| Doctor Name: | DR. VICTOR VAN WIESNER |
| NPI Number: | 1043529183 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, NCC, CCMHC, MBA |
| License Number: | 14557 |
| Business Practice Address: | 9595 Six Pines Dr Suite 8210 The Woodlands, TX - 773801531 |
| Business Phone Number: | 2818257789 |
| Business Fax Number: | |
| Mailing Address: | 7820 Mary Katheryns Xing, CONROE |
| State: | TX |
| Postal Code: | 773044979 |
| Phone Number: | 2818257789 |
| Fax Number: | 8326316281 |
| NPI Enumeration Date: | 10/06/2010 |
| NPI Last Update Date: | 10/06/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 14557 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |