Provider Demographics
NPI:1295281566
Name:WEATHERS, CHRISTOPHER H (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:H
Last Name:WEATHERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18 JMA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-5010
Mailing Address - Country:US
Mailing Address - Phone:575-770-7139
Mailing Address - Fax:
Practice Address - Street 1:1215 GUSDORF RD STE A
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6914
Practice Address - Country:US
Practice Address - Phone:575-770-7139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-097151041C0700X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility