Provider Demographics
NPI:1063811735
Name:WEAVER, CHRISTOPHER G (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:G
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 CALDER ST
Mailing Address - Street 2:STE 640
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1115
Mailing Address - Country:US
Mailing Address - Phone:214-396-3960
Mailing Address - Fax:214-396-3962
Practice Address - Street 1:2615 CALDER ST
Practice Address - Street 2:STE 640
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1115
Practice Address - Country:US
Practice Address - Phone:214-396-3960
Practice Address - Fax:214-396-3962
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36418103T00000X
TX7323103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist