Provider Demographics
NPI:1780114082
Name:WEED, LORA LEE (MA, LMHC, MHP)
Entity type:Individual
Prefix:
First Name:LORA
Middle Name:LEE
Last Name:WEED
Suffix:
Gender:F
Credentials:MA, LMHC, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 4TH AVE E STE 413
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-1189
Mailing Address - Country:US
Mailing Address - Phone:360-878-8248
Mailing Address - Fax:
Practice Address - Street 1:203 4TH AVE E STE 413
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1189
Practice Address - Country:US
Practice Address - Phone:360-490-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA100741Medicaid