Provider Demographics
NPI:1295884807
Name:WEISS, MARK HARBIN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HARBIN
Last Name:WEISS
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 1:1835 UNION AVE
Mailing Address - Street 2:#312
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3949
Mailing Address - Country:US
Mailing Address - Phone:901-725-7612
Mailing Address - Fax:901-725-7619
Practice Address - Street 1:1835 UNION AVE
Practice Address - Street 2:#312
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3949
Practice Address - Country:US
Practice Address - Phone:901-725-7612
Practice Address - Fax:901-725-7619
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4335359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist