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General NPI Number Information
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NPI Number | 1619338704
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Entity Type | Individual
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Provider Name | PAUL SEBASTIAN WEAVER MFT
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Gender | Male
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 8824 LIVE OAK AVE
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-8570
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Country | US
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Telephone | 228-765-1193
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Fax |
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Provider Business Mailing Address
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Address Line | 8824 LIVE OAK AVE
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-8570
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Country | US
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Telephone | 228-765-1193
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | M.1600009
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3669
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License Number State | FL
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