Provider Demographics
NPI:1265441372
Name:WEIR, MARILOU CHERIE' (MA,LPC,LMFT,LCDC)
Entity type:Individual
Prefix:MS
First Name:MARILOU
Middle Name:CHERIE'
Last Name:WEIR
Suffix:
Gender:F
Credentials:MA,LPC,LMFT,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 CALLAGHAN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1127
Mailing Address - Country:US
Mailing Address - Phone:210-521-4833
Mailing Address - Fax:210-521-8561
Practice Address - Street 1:5825 CALLAGHAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1124
Practice Address - Country:US
Practice Address - Phone:210-521-4833
Practice Address - Fax:210-521-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095378801Medicaid