| Doctor Name: | HEIDI WEAVER |
| NPI Number: | 1013291160 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC,NCC |
| License Number: | LPC4777 |
| Business Practice Address: | 2273 S Vista Ave Suite 190 Boise, ID - 837057341 |
| Business Phone Number: | 2083432737 |
| Business Fax Number: | |
| Mailing Address: | 348 Idaho St, ARCO |
| State: | ID |
| Postal Code: | 832134902 |
| Phone Number: | 2089212210 |
| Fax Number: | |
| NPI Enumeration Date: | 10/07/2011 |
| NPI Last Update Date: | 10/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LPC4777 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |