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NPI Code Detail

MEDICARE: MARY ELIZABETH WEAVER

MEDICARE: MARY ELIZABETH WEAVER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorA2309005AR

General Provider Information

NPI Number : 1154278810
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH WEAVER
Provider Business Mailing Address
First Line : 27785 HIGHWAY 62
Second Line :
City : PROCTOR
State : OK
Zip : 74457-3427
Country : US
Telephone Number : 479-966-7640
Fax Number :
Provider Business Practice Location Address
First Line : 847 S DOGWOOD ST
Second Line :
City : SILOAM SPRINGS
State : AR
Zip : 72761-3915
Country : US
Telephone Number : 479-966-7640
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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Directions to “ MARY ELIZABETH WEAVER ” Practice Location

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