Provider Demographics
NPI:1992471395
Name:WEED, NATHAN CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CHARLES
Last Name:WEED
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2194 W KELLY DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-8586
Mailing Address - Country:US
Mailing Address - Phone:989-854-8566
Mailing Address - Fax:989-774-2553
Practice Address - Street 1:1280 E CAMPUS DR CARLS CENTER
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48859-0001
Practice Address - Country:US
Practice Address - Phone:989-854-8566
Practice Address - Fax:989-774-2553
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical