Provider Demographics
NPI:1578179271
Name:WEBER, DAVID MICHAEL I (PSYD / NCSP / LEP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:WEBER
Suffix:I
Gender:M
Credentials:PSYD / NCSP / LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 DAVID E COOK WAY
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-2505
Mailing Address - Country:US
Mailing Address - Phone:559-940-5044
Mailing Address - Fax:
Practice Address - Street 1:1680 DAVID E COOK WAY
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-2505
Practice Address - Country:US
Practice Address - Phone:559-940-5044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2567103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool