Individual
MR. TIMOTHY M WEAVER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
413 SIPAPU ROAD, BOX 6952, TAOS, NM 87571
(505) 758-5857
(505) 758-2832
Mailing address
HC 81 BOX 13, QUESTA, NM 87556
(505) 770-6737
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0088771
NM
Other
Enumeration date
05/20/2006
Last updated
07/08/2007
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