Provider Demographics
NPI:1073909511
Name:WEATHERBY & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WEATHERBY & ASSOCIATES, LLC
Other - Org Name:WEATHERBY ASSET MANAGEMENT GROUP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WEATHERBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-784-0819
Mailing Address - Street 1:1323 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-3352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1323 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-3352
Practice Address - Country:US
Practice Address - Phone:573-470-6826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility