Provider Demographics
NPI:1528337128
Name:WEATHERS, CORIE BRANNON (LPC)
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:BRANNON
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5553 PERDITA DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-5878
Mailing Address - Country:US
Mailing Address - Phone:719-439-3693
Mailing Address - Fax:
Practice Address - Street 1:5553 PERDITA DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-5878
Practice Address - Country:US
Practice Address - Phone:719-439-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006684101YP2500X
COLPC5674101YP2500X
VA0701006789101YP2500X
TX83152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty