=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710176292
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE JEAN WEEKS PH.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2007
-----------------------------------------------------
Last Update Date | 10/19/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 818 S WASHINGTON ST
-----------------------------------------------------
City | MOSCOW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843-3049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-882-8514
-----------------------------------------------------
Fax | 208-882-2784
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 818 SOUTH WASHINGTON ST
-----------------------------------------------------
City | MOSOCW
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-882-8514
-----------------------------------------------------
Fax | 208-882-2784
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LCPC 217
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | PSY-202119
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------