Provider Demographics
NPI:1881837649
Name:WEIS, PATRICK JEROME (PSYD, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:JEROME
Last Name:WEIS
Suffix:
Gender:M
Credentials:PSYD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1229 E SEMINOLE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2227
Mailing Address - Country:US
Mailing Address - Phone:417-820-2170
Mailing Address - Fax:417-820-6598
Practice Address - Street 1:1229 E SEMINOLE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-2170
Practice Address - Fax:417-820-6598
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007037811101YP2500X
MO2010036623103TC0700X
103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical