Provider Demographics
NPI:1184631038
Name:WEAVER, RAYMOND JOHN (LMFT)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOHN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18023 SKY PARK CIR
Mailing Address - Street 2:SUITE G
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6521
Mailing Address - Country:US
Mailing Address - Phone:949-939-5112
Mailing Address - Fax:
Practice Address - Street 1:18023 SKY PARK CIR
Practice Address - Street 2:SUITE G
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6521
Practice Address - Country:US
Practice Address - Phone:714-371-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45917106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health