Provider Demographics
NPI:1255944179
Name:WEAVER, JULIE A (LMFT)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:A
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:17130 VAN BUREN BLVD # 52
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-5905
Mailing Address - Country:US
Mailing Address - Phone:951-858-6499
Mailing Address - Fax:
Practice Address - Street 1:5053 LA MART DR STE 105
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-5993
Practice Address - Country:US
Practice Address - Phone:951-858-6499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120720106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty