Provider Demographics
NPI:1689978801
Name:WELLER, CHRISTY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:
Last Name:WELLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 11TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5101
Mailing Address - Country:US
Mailing Address - Phone:720-210-9534
Mailing Address - Fax:720-210-9534
Practice Address - Street 1:2027 11TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5101
Practice Address - Country:US
Practice Address - Phone:720-210-9534
Practice Address - Fax:720-210-9534
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical