Provider Demographics
NPI:1023080496
Name:MUSSELWHITE-WEAVER, PATRICIA JO (MA, LMHC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:MUSSELWHITE-WEAVER
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021C S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-5552
Mailing Address - Country:US
Mailing Address - Phone:941-922-6404
Mailing Address - Fax:941-926-8724
Practice Address - Street 1:7021C S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-5552
Practice Address - Country:US
Practice Address - Phone:941-922-6404
Practice Address - Fax:941-926-8724
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1969101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL768770200Medicaid
FL768770200Medicaid
FL650408680OtherTIN