Provider Demographics
NPI:1467523738
Name:WEAVER, LISA LORAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LORAINE
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 1:701 N POST OAK RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3839
Mailing Address - Country:US
Mailing Address - Phone:713-781-2220
Mailing Address - Fax:713-688-0101
Practice Address - Street 1:701 N POST OAK RD
Practice Address - Street 2:SUITE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3839
Practice Address - Country:US
Practice Address - Phone:713-781-2220
Practice Address - Fax:713-688-0101
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3812103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098740602Medicaid
TX00H71ROtherBLUE CROSS
TX098740602Medicaid
TX098740602Medicaid