Provider Demographics
NPI:1891020004
Name:WEAVER, TIMOTHY L (LMHC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11736 NEWBERRY GROVE LOOP
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-3902
Mailing Address - Country:US
Mailing Address - Phone:908-415-0632
Mailing Address - Fax:
Practice Address - Street 1:11736 NEWBERRY GROVE LOOP
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-3902
Practice Address - Country:US
Practice Address - Phone:908-415-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health