Basic Information
Provider Information
NPI: 1821398124
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEAVER
FirstName: JULENE
MiddleName: T
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 905 SPRUCE ST
Address2: SUITE 300
City: SEATTLE
State: WA
PostalCode: 981042474
CountryCode: US
TelephoneNumber: 2065483012
FaxNumber: 2064618382
Practice Location
Address1: 1930 POST ALLEY
Address2:  
City: SEATTLE
State: WA
PostalCode: 981011015
CountryCode: US
TelephoneNumber: 2067284143
FaxNumber: 2069561018
Other Information
ProviderEnumerationDate: 11/02/2010
LastUpdateDate: 12/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XLH60160390WAY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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