Provider Demographics
NPI:1679264345
Name:WEAKLEY, QUINN BECKETT
Entity Type:Individual
Prefix:
First Name:QUINN
Middle Name:BECKETT
Last Name:WEAKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 N 291 HWY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1045
Mailing Address - Country:US
Mailing Address - Phone:816-384-0099
Mailing Address - Fax:
Practice Address - Street 1:523 N 291 HWY
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1045
Practice Address - Country:US
Practice Address - Phone:816-384-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician