Provider Demographics
NPI:1487190302
Name:PATRICIA MUSSELWHITE-WEAVER, LMHC
Entity Type:Organization
Organization Name:PATRICIA MUSSELWHITE-WEAVER, LMHC
Other - Org Name:PATRICIA MUSSELWHITE-WEAVER, LMHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MUSSELWHITE-WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-922-6404
Mailing Address - Street 1:7021C S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5552
Mailing Address - Country:US
Mailing Address - Phone:941-922-6404
Mailing Address - Fax:941-926-8724
Practice Address - Street 1:7021C S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5552
Practice Address - Country:US
Practice Address - Phone:941-922-6404
Practice Address - Fax:941-926-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768770200Medicaid