Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 581 | WA |
N | 103T00000X | Psychologist | 581 | WA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 581 | WA |
NPI | 1003957796 |
---|---|
Provider Name | Dr. Lawrence Ray Weathers |
First Address | Spokane, WA 99223-1845 |
Second Address | Spokane, WA 99223-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |