Provider Demographics
NPI:1154591584
Name:WEEMS, JEANETTE ANN (LPC-S, CRC, MEDIATOR)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ANN
Last Name:WEEMS
Suffix:
Gender:F
Credentials:LPC-S, CRC, MEDIATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 RAY WHITE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9105
Mailing Address - Country:US
Mailing Address - Phone:214-228-3916
Mailing Address - Fax:855-529-3367
Practice Address - Street 1:9500 RAY WHITE RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:214-228-3916
Practice Address - Fax:855-529-3367
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2018-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20126101YM0800X, 101YP2500X
225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Multi-Specialty