Provider Demographics
NPI:1164679148
Name:WEAVINGS WELLNESS GROUP ADMINISTRATIVE SERVICES, LLC
Entity Type:Organization
Organization Name:WEAVINGS WELLNESS GROUP ADMINISTRATIVE SERVICES, LLC
Other - Org Name:WEAVINGS WELLNESS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:FLAHERTY
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-327-0020
Mailing Address - Street 1:2499 S CAPITAL OF TEXAS HWY
Mailing Address - Street 2:#A-200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7762
Mailing Address - Country:US
Mailing Address - Phone:512-327-0020
Mailing Address - Fax:512-327-0030
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:#A-200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7762
Practice Address - Country:US
Practice Address - Phone:512-327-0020
Practice Address - Fax:512-327-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty