Provider Demographics
NPI:1699080820
Name:WEATHERSPOON, CEDRIC LAMAR (LMFT)
Entity type:Individual
Prefix:MR
First Name:CEDRIC
Middle Name:LAMAR
Last Name:WEATHERSPOON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18696
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-0696
Mailing Address - Country:US
Mailing Address - Phone:612-226-7799
Mailing Address - Fax:612-781-2428
Practice Address - Street 1:227 COLFAX AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405
Practice Address - Country:US
Practice Address - Phone:612-226-7799
Practice Address - Fax:612-781-2428
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist