Provider Demographics
NPI:1801972104
Name:WEATHERFORD, SHELBY LEE JR (M MFT)
Entity type:Individual
Prefix:MR
First Name:SHELBY
Middle Name:LEE
Last Name:WEATHERFORD
Suffix:JR
Gender:M
Credentials:M MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5442
Mailing Address - Country:US
Mailing Address - Phone:325-676-3718
Mailing Address - Fax:325-676-1196
Practice Address - Street 1:702 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5442
Practice Address - Country:US
Practice Address - Phone:325-676-3718
Practice Address - Fax:325-676-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12237101YP2500X
TX4474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist