Provider Demographics
NPI:1619338704
Name:WEAVER, PAUL SEBASTIAN (MFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SEBASTIAN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8824 LIVE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-8570
Mailing Address - Country:US
Mailing Address - Phone:228-765-1193
Mailing Address - Fax:
Practice Address - Street 1:8824 LIVE OAK AVE
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-8570
Practice Address - Country:US
Practice Address - Phone:228-765-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.1600009106H00000X
FLMT3669106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist