Provider Demographics
NPI:1346650660
Name:WEAVER, TRISHA N (MED, LPC, LBS)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:N
Last Name:WEAVER
Suffix:
Gender:F
Credentials:MED, LPC, LBS
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:N
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND DR
Mailing Address - Street 2:PO BOX 597
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:717-285-5302
Practice Address - Street 1:790 NEW HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2137
Practice Address - Country:US
Practice Address - Phone:717-390-0353
Practice Address - Fax:717-390-1812
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH000726103K00000X
PAPC008892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst