Provider Demographics
NPI:1023251147
Name:WEED, MICHAEL LEE (LC,SW,)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:WEED
Suffix:
Gender:M
Credentials:LC,SW,
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:LEE
Other - Last Name:WEED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:900 N WALNUT CREEK DR
Mailing Address - Street 2:SUITE 100, P.O. BOX 279
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 BROOKFIELD LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2565
Practice Address - Country:US
Practice Address - Phone:817-239-0823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX369571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical