Individual
SHANNON WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3100 PINEBROOK RD STE 1250B, PARK CITY, UT 84098-5663
(801) 631-7476
Mailing address
882 S 550 E, HEBER CITY, UT 84032-4547
(801) 631-7476
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5121600-3501
UT
Other
Enumeration date
04/24/2021
Last updated
04/24/2021
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