Provider Demographics
NPI:1235842048
Name:WIESE, ANDREW DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:WIESE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
Mailing Address - Street 2:1977 BUTLER BLVD
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-3080
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
Practice Address - Street 2:1977 BUTLER BLVD
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-3080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39372103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical