Provider Demographics
NPI:1467615146
Name:WEAVER, MICHAEL KEAN (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KEAN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 SW 34TH CIRCLE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7479
Mailing Address - Country:US
Mailing Address - Phone:352-861-4481
Mailing Address - Fax:352-237-8363
Practice Address - Street 1:3304 SW 34TH CIRCLE
Practice Address - Street 2:SUITE 202
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7479
Practice Address - Country:US
Practice Address - Phone:352-861-4481
Practice Address - Fax:352-237-8363
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2631103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z6331OtherBCBS OF FL