Healthcare Provider Details

I. General information

NPI: 1255510400
Provider Name (Legal Business Name): DAVID M WELLER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEPARTMENT OF THE AIR FORCE 86 MDG OPC 02 BOX 60
APO AE
09094-9001
US

IV. Provider business mailing address

DEPARTMENT OF THE AIR FORCE 86 MDG OPC 02 BOX 60
APO AE
09094-9001
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax:
Mailing address:
  • Phone: 314-479-2609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4860689-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: