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General NPI Number Information
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NPI Number | 1861745754
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Entity Type | Individual
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Provider Name | LAUREN REBEKAH GRAY WEIR MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 2578 BROADWAY # 607
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City | NEW YORK
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State | NY
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Zip | 10025-5642
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Country | US
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Telephone | 222-222-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 5301 WALSH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63109-3225
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Country | US
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Telephone | 222-222-2222
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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