Provider Demographics
NPI:1992544639
Name:WEAVER, KRISTA RAY
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RAY
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 N CENTRAL EXPY STE 1625
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-1806
Mailing Address - Country:US
Mailing Address - Phone:214-530-0021
Mailing Address - Fax:214-530-0021
Practice Address - Street 1:13612 MIDWAY RD STE 605
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-4324
Practice Address - Country:US
Practice Address - Phone:214-530-0021
Practice Address - Fax:214-530-0021
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical