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General NPI Number Information
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NPI Number | 1396839171
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Entity Type | Individual
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Provider Name | IVAN RAY WEIR LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 104 HARDIN LN
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City | SOMERSET
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State | KY
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Zip | 42503-3800
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Country | US
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Telephone | 606-676-0786
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Fax | 606-676-9737
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Provider Business Mailing Address
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Address Line | 1125 LANE ALLEN RD
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City | LEXINGTON
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State | KY
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Zip | 40504-2019
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Country | US
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Telephone | 606-676-0786
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Fax | 606-676-9737
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 429
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License Number State | KY
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