Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | P-1423 | NE |
NPI | 1003362146 |
---|---|
Provider Name | Brett Weaver |
First Address | Gordon, NE 69343-1709 |
Second Address | Gordon, NE 69343-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 29/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
470734376-86 | (05) | NE |