Provider Demographics
NPI:1326044801
Name:WEISS, JULES CARY (EDD)
Entity Type:Individual
Prefix:MR
First Name:JULES
Middle Name:CARY
Last Name:WEISS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6447
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-6447
Mailing Address - Country:US
Mailing Address - Phone:903-838-3322
Mailing Address - Fax:903-838-9034
Practice Address - Street 1:1002 TEXAS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5107
Practice Address - Country:US
Practice Address - Phone:903-838-3322
Practice Address - Fax:903-838-9034
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036038001Medicaid
TX00T57LMedicare PIN