Healthcare Provider Details

I. General information

NPI: 1710176292
Provider Name (Legal Business Name): CATHERINE JEAN WEEKS PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 S WASHINGTON ST
MOSCOW ID
83843-3049
US

IV. Provider business mailing address

818 SOUTH WASHINGTON ST
MOSOCW ID
83843
US

V. Phone/Fax

Practice location:
  • Phone: 208-882-8514
  • Fax: 208-882-2784
Mailing address:
  • Phone: 208-882-8514
  • Fax: 208-882-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC 217
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-202119
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: