Provider Demographics
NPI:1881759165
Name:WEIR, DIANE SELLERS (LCSW MSW)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:SELLERS
Last Name:WEIR
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HILL ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3008
Mailing Address - Country:US
Mailing Address - Phone:512-303-4456
Mailing Address - Fax:512-303-3639
Practice Address - Street 1:1301 HILL ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3008
Practice Address - Country:US
Practice Address - Phone:512-303-4456
Practice Address - Fax:512-303-3639
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCSW 03352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
0065DLOtherBCBS
TX102931601Medicaid
TX102931601Medicaid