Provider Demographics
NPI:1154860021
Name:WEAVER, SHAY WILLS (BA, QMHP, LCDC-I)
Entity Type:Individual
Prefix:
First Name:SHAY
Middle Name:WILLS
Last Name:WEAVER
Suffix:
Gender:F
Credentials:BA, QMHP, LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 WESTWAY PL STE 530
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-1000
Mailing Address - Country:US
Mailing Address - Phone:972-814-8655
Mailing Address - Fax:
Practice Address - Street 1:320 WESTWAY PL STE 530
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1000
Practice Address - Country:US
Practice Address - Phone:972-814-8655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32175101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor