Healthcare Provider Details

I. General information

NPI: 1346650660
Provider Name (Legal Business Name): TRISHA N WEAVER M.ED., LPC, LBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRISHA N PARKER

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 NEW HOLLAND AVE
LANCASTER PA
17602-2137
US

IV. Provider business mailing address

320 HIGHLAND DR PO BOX 597
MOUNTVILLE PA
17554-1232
US

V. Phone/Fax

Practice location:
  • Phone: 717-390-0353
  • Fax: 717-390-1812
Mailing address:
  • Phone: 717-285-7121
  • Fax: 717-285-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008892
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH000726
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: