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General NPI Number Information
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NPI Number | 1992411722
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Entity Type | Individual
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Provider Name | CLARA CHRISTINE WEAKS LPC ASSOCIATE
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Gender | Female
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 01/25/2023
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Provider Practice Location Address
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Address Line | 431 E STATE HIGHWAY 114 FL 1
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City | SOUTHLAKE
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State | TX
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Zip | 76092-4412
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Country | US
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Telephone | 844-824-8775
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Fax |
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Provider Business Mailing Address
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Address Line | 360 GRAN VIA APT 3104
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City | IRVING
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State | TX
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Zip | 75039-0123
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Country | US
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Telephone | 972-965-6503
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 90824
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License Number State | TX
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