Provider Demographics
NPI:1619698495
Name:WEATHERLY, CHRISTOPHER PAUL (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:WEATHERLY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7333 LINDELL BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4409
Mailing Address - Country:US
Mailing Address - Phone:850-556-1364
Mailing Address - Fax:
Practice Address - Street 1:7333 LINDELL BLVD APT B
Practice Address - Street 2:
Practice Address - City:UNIVERSITY CITY
Practice Address - State:MO
Practice Address - Zip Code:63130-4409
Practice Address - Country:US
Practice Address - Phone:850-556-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170269911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical