Individual
DR. KEVIN S WEATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
5604 WESLEY ST STE 104, GREENVILLE, TX 75402-6326
(903) 883-7792
(903) 488-5303
Mailing address
5604 WESLEY ST STE 104, GREENVILLE, TX 75402-6326
(903) 883-7792
(903) 488-5303
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
37657
TX
103TC0700X
Clinical Psychologist
37657
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375679301
—
TX
Enumeration date
06/20/2012
Last updated
07/06/2023
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