Provider Demographics
NPI:1396874640
Name:LAWRENCE R WEATHERS, PHD, MARY B WEATHERS, PHD, PS
Entity type:Organization
Organization Name:LAWRENCE R WEATHERS, PHD, MARY B WEATHERS, PHD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WEATHERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:509-448-6462
Mailing Address - Street 1:6921 E JAMIESON RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-1845
Mailing Address - Country:US
Mailing Address - Phone:509-448-6462
Mailing Address - Fax:806-209-8854
Practice Address - Street 1:6921 E JAMIESON RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-1845
Practice Address - Country:US
Practice Address - Phone:509-448-6462
Practice Address - Fax:806-209-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA789103T00000X
WA581103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty