Provider Demographics
NPI:1003957796
Name:WEATHERS, LAWRENCE RAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAY
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6921 E JAMIESON RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1845
Mailing Address - Country:US
Mailing Address - Phone:509-448-6462
Mailing Address - Fax:
Practice Address - Street 1:6921 E JAMIESON RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1845
Practice Address - Country:US
Practice Address - Phone:509-448-6462
Practice Address - Fax:806-209-8854
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA581103T00000X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent