| Doctor Name: | BEN LOUIS WEAVER |
| NPI Number: | 1043410129 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC, NCC, QMHP |
| License Number: | C3095 |
| Business Practice Address: | 58646 Mcnulty Way Saint Helens, OR - 970516210 |
| Business Phone Number: | 5033975211 |
| Business Fax Number: | 5034382194 |
| Mailing Address: | Po Box 1234, SAINT HELENS |
| State: | OR |
| Postal Code: | 970518234 |
| Phone Number: | 5033975211 |
| Fax Number: | 5034382194 |
| NPI Enumeration Date: | 07/18/2007 |
| NPI Last Update Date: | 04/09/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | C3095 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |