Provider Demographics
NPI:1922304831
Name:WEIR, SHIRLEY DENISE (LMFT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:DENISE
Last Name:WEIR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 N RIVER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8947
Mailing Address - Country:US
Mailing Address - Phone:630-718-0717
Mailing Address - Fax:630-718-0747
Practice Address - Street 1:640 N RIVER RD STE 108
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-8947
Practice Address - Country:US
Practice Address - Phone:630-718-0717
Practice Address - Fax:630-718-0747
Is Sole Proprietor?:No
Enumeration Date:2011-02-10
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170GMedicaid