Provider Demographics
NPI:1689070625
Name:WELLING, ANDREA (NCC, BC-DMT, CMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WELLING
Suffix:
Gender:F
Credentials:NCC, BC-DMT, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 W GENTILE ST
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3041
Mailing Address - Country:US
Mailing Address - Phone:801-814-4916
Mailing Address - Fax:
Practice Address - Street 1:880 HERITAGE PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5674
Practice Address - Country:US
Practice Address - Phone:801-814-4916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8939807-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health