Individual
KEITH W WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LCSW
Contact information
Practice address
314 W 1700 S, OREM, UT 84058-7542
(801) 610-9313
Mailing address
19999 DOTTIE LN, PRINCETON, MO 64673-8023
(801) 688-8240
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
096467
NY
1041C0700X
Clinical Social Worker
2022013753
MO
1041C0700X
Clinical Social Worker
Primary
323944-3501
UT
1041C0700X
Clinical Social Worker
TH00946205
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
096467
LCSW NY LICENSING
NY
01
—
2022013753
LICENSED CLINICAL SOCIAL WORKER
MO
01
—
323944-3501
STATE OF UTAH
UT
01
—
TH00946205
LCSW - WV LICENSING
WV
Enumeration date
02/27/2019
Last updated
12/07/2023
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