| Doctor Name: | MR. KENT ALAN WEISHAUS |
| NPI Number: | 1588963573 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.C.S.W. |
| License Number: | LCS 28772 |
| Business Practice Address: | 26120 Ridge View Dr. Idyllwild, CA - 925490001 |
| Business Phone Number: | 9512885228 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1613, IDYLLWILD |
| State: | CA |
| Postal Code: | 925491613 |
| Phone Number: | 2133091729 |
| Fax Number: | |
| NPI Enumeration Date: | 03/16/2011 |
| NPI Last Update Date: | 10/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS 28772 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |