Provider Demographics
NPI:1487006979
Name:WEAKS, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:WEAKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST AVE E
Mailing Address - Street 2:SUITE 11
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4978
Mailing Address - Country:US
Mailing Address - Phone:406-544-5517
Mailing Address - Fax:
Practice Address - Street 1:307 1ST AVE E
Practice Address - Street 2:SUITE 11
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4978
Practice Address - Country:US
Practice Address - Phone:406-544-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-7654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional