Provider Demographics
NPI:1174662399
Name:WEIFORD, KEISHA (MFT)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:WEIFORD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 W LAKE MEAD BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-7648
Mailing Address - Country:US
Mailing Address - Phone:702-395-8417
Mailing Address - Fax:702-242-4429
Practice Address - Street 1:8440 W LAKE MEAD BLVD STE 206
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-7648
Practice Address - Country:US
Practice Address - Phone:702-395-8417
Practice Address - Fax:702-242-4429
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist