Nicole Elizabeth Weakley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

51703 Issued in TX

Practice address

1127 Judson Rd Ste 100
Longview, TX 75601-5167

Phone

(903) 563-4297

NPI assigned

Feb 17, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Supportive Care LLC

  • Clinical Psychologist
  • Garland, TX
  • NPI 1477895043
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1581897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583712000000",
    "number": "1316570435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 COUNTY ROAD NE 2050",
            "city": "MOUNT VERNON",
            "state": "TX",
            "postal_code": "754575731",
            "telephone_number": "903-563-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 JUDSON RD STE 100",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756015167",
            "telephone_number": "903-563-4297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1508 W Fairmont St Ste A",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756044500",
            "country_code": "US",
            "telephone_number": "903-563-4297",
            "fax_number": "903-680-0679",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEAKLEY",
        "first_name": "NICOLE",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-17",
        "last_updated": "2020-03-09",
        "certification_date": "2020-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "51703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tammy Watson-Smith
• Babette Watson
• Michaela Watson, LPC
• Robin Turner Watson, APRN, PMHNP-BC
• Ashlee Watterson, LCDC
• Graham Oliver Weaver, MD
• Eunice Webb, MD
• Katresa Webb, RN
• Jacqueline Moran Weber, CNM
• Lauren Weber, LCSW

• Clinical Social Worker in Longview, TX
• Providers in Longview, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.