MEDICARE: LISA L. WEAVER, PH.D., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	23812	TX

General Provider Information

NPI Number	:	1700010790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA L. WEAVER, PH.D., P.C.

Provider Business Mailing Address
First Line	:	701 N POST OAK DR.
Second Line	:	SUITE 320
City	:	HOUSTON
State	:	TX
Zip	:	77024-3839
Country	:	US
Telephone Number	:	713-781-2220
Fax Number	:	713-688-0101

Provider Business Practice Location Address
First Line	:	701 N. POST OAK DR.
Second Line	:	SUITE 320
City	:	HOUSTON
State	:	TX
Zip	:	77024-3871
Country	:	US
Telephone Number	:	713-781-2220
Fax Number	:	713-688-0101

Authorized Official
Title or Position	:	BUSINESS OFFICE
Name	:	DWIGHT F YODERS
Credential	:
Telephone Number	:	281-429-2300

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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