Provider Demographics
NPI:1700010790
Name:LISA L. WEAVER, PH.D., P.C.
Entity Type:Organization
Organization Name:LISA L. WEAVER, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:F
Authorized Official - Last Name:YODERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-429-2300
Mailing Address - Street 1:701 N POST OAK DR.
Mailing Address - Street 2:SUITE 320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3839
Mailing Address - Country:US
Mailing Address - Phone:713-781-2220
Mailing Address - Fax:713-688-0101
Practice Address - Street 1:701 N. POST OAK DR.
Practice Address - Street 2:SUITE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3871
Practice Address - Country:US
Practice Address - Phone:713-781-2220
Practice Address - Fax:713-688-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23812103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty