Provider Demographics
NPI:1538557939
Name:WEED, CANDICE ELAINE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELAINE
Last Name:WEED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:ELAINE
Other - Last Name:PRIMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1421 S BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-3607
Mailing Address - Country:US
Mailing Address - Phone:918-599-7999
Mailing Address - Fax:
Practice Address - Street 1:1421 S BOSTON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-3607
Practice Address - Country:US
Practice Address - Phone:918-599-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical