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General NPI Number Information
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NPI Number | 1154278810
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Entity Type | Individual
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Provider Name | MARY ELIZABETH WEAVER
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Gender | Female
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 847 S DOGWOOD ST
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City | SILOAM SPRINGS
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State | AR
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Zip | 72761-3915
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Country | US
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Telephone | 479-966-7640
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Fax |
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Provider Business Mailing Address
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Address Line | 27785 HIGHWAY 62
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City | PROCTOR
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State | OK
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Zip | 74457-3427
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Country | US
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Telephone | 479-966-7640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A2309005
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License Number State | AR
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