Provider Demographics
NPI:1184016883
Name:WEAVER, KATIE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:WEAVER
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 1:6320 EVERGREEN WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-4560
Mailing Address - Country:US
Mailing Address - Phone:425-220-7042
Mailing Address - Fax:425-512-8049
Practice Address - Street 1:6320 EVERGREEN WAY STE 201
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-4560
Practice Address - Country:US
Practice Address - Phone:425-220-7042
Practice Address - Fax:425-512-8049
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2019-03-05
Deactivation Date:2019-02-24
Deactivation Code:
Reactivation Date:2019-03-05
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WALF60914001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst