Provider Demographics
NPI:1578394334
Name:WEEAKS, CORBY (LPC)
Entity type:Individual
Prefix:
First Name:CORBY
Middle Name:
Last Name:WEEAKS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 S KIMBALL PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1658
Mailing Address - Country:US
Mailing Address - Phone:325-450-4784
Mailing Address - Fax:
Practice Address - Street 1:1015 W HAYS ST STE 105
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5412
Practice Address - Country:US
Practice Address - Phone:208-398-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID10589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health