Provider Demographics
NPI:1275569022
Name:WEAVER, CARROL R (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARROL
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6307 WATERFORD BLVD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1125
Mailing Address - Country:US
Mailing Address - Phone:405-848-1191
Mailing Address - Fax:405-848-1224
Practice Address - Street 1:6307 WATERFORD BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1125
Practice Address - Country:US
Practice Address - Phone:405-848-1191
Practice Address - Fax:405-848-1224
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK541103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist