Healthcare Provider Details

I. General information

NPI: 1184631038
Provider Name (Legal Business Name): RAYMOND JOHN WEAVER LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18023 SKY PARK CIR SUITE G
IRVINE CA
92614-6521
US

IV. Provider business mailing address

18023 SKY PARK CIR SUITE G
IRVINE CA
92614-6521
US

V. Phone/Fax

Practice location:
  • Phone: 714-371-6050
  • Fax:
Mailing address:
  • Phone: 949-939-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number45917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: