Provider Demographics
NPI:1861436255
Name:WEAVER, AMY L (LMFT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 N CAPITOL AVE
Mailing Address - Street 2:STE 442
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1218
Mailing Address - Country:US
Mailing Address - Phone:317-962-8613
Mailing Address - Fax:
Practice Address - Street 1:1812 N CAPITOL AVE
Practice Address - Street 2:SUITE 442
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1218
Practice Address - Country:US
Practice Address - Phone:317-962-8613
Practice Address - Fax:317-962-5961
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000368A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health