Provider Demographics
NPI:1023666914
Name:WEIBERT, ANDREW J
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:WEIBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3139 E 2890 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1329
Mailing Address - Country:US
Mailing Address - Phone:925-354-6152
Mailing Address - Fax:
Practice Address - Street 1:225 N BLUFF ST STE 5
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4568
Practice Address - Country:US
Practice Address - Phone:435-229-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13355097-6009101YM0800X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health