Provider Demographics
NPI:1720766785
Name:WEATHERS DEVELOPMENTAL & BEHAVIORAL THERAPY
Entity Type:Organization
Organization Name:WEATHERS DEVELOPMENTAL & BEHAVIORAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KASI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:501-259-3720
Mailing Address - Street 1:3133 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-9557
Mailing Address - Country:US
Mailing Address - Phone:501-259-3720
Mailing Address - Fax:
Practice Address - Street 1:3133 MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-9557
Practice Address - Country:US
Practice Address - Phone:501-259-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty