Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 25801 | TX |
Y | 103TC0700X | Clinical Psychologist | 25801 | TX |
N | 103G00000X | Clinical Psychologist | 25801 | TX |
N | 103TC0700X | Clinical Psychologist | 25801 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 25801 | TX |
NPI | 1346370442 |
---|---|
Provider Name | Dr. Kris Weber |
First Address | Dallas, TX 75231-2321 |
Second Address | Dallas, TX 75231-2321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 27/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2074405 | CIGNA ID (01) | TX |
6162197 | UNITED HEALTH CARE (01) | TX |
7226254 | AETNA ID (01) | TX |
S42998 | (02) | TX |