Provider Demographics
NPI:1659582450
Name:WEAVER, ZELLA LUNA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ZELLA
Middle Name:LUNA
Last Name:WEAVER
Suffix:
Gender:F
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:PO BOX 3804
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-3804
Mailing Address - Country:US
Mailing Address - Phone:505-860-5882
Mailing Address - Fax:
Practice Address - Street 1:US HYW160 S MP 364.3
Practice Address - Street 2:
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033-0368
Practice Address - Country:US
Practice Address - Phone:928-697-4000
Practice Address - Fax:928-697-4145
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-068021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical