Provider Demographics
NPI:1285776070
Name:WEAVER, TINA R (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:R
Last Name:WEAVER
Suffix:
Gender:
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 W RIVERSIDE AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-1099
Mailing Address - Country:US
Mailing Address - Phone:509-263-4293
Mailing Address - Fax:
Practice Address - Street 1:905 W RIVERSIDE AVE STE 305
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-1099
Practice Address - Country:US
Practice Address - Phone:509-263-4293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009898101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health