Weatherly, Kevin S

Weatherly, Kevin S is an sole proprietor health care provider with primary practice located at 5604 Wesley St Ste 104 , Greenville TX 75402-6326. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Psychologist is his primary health care specialty. Weatherly, Kevin S can be contacted via phone (903) 883-7792.

Contact Information

Primary practice address
5604 Wesley St Ste 104 Greenville TX 75402-6326
Phone: (903) 883-7792
Fax: (903) 488-5303
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 37657 Texas
Behavioral Health & Social Service Providers / Psychologist 103T00000X 37657 Texas

Profile Details

NPI number 1164785556
LBN Legal business name Weatherly, Kevin S
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 20th, 2012
Last updated Jul 6th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164785556 NPPES
Texas MEDICAID 375679301

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