Provider Demographics
NPI:1033657564
Name:WEISMAN, GINA (LMFT)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9260 E RAINTREE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7310
Mailing Address - Country:US
Mailing Address - Phone:602-345-0621
Mailing Address - Fax:
Practice Address - Street 1:9260 E RAINTREE DR STE 120
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7310
Practice Address - Country:US
Practice Address - Phone:602-345-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15618106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist