Healthcare Provider Details

I. General information

NPI: 1235429168
Provider Name (Legal Business Name): MELISSA WEATHERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 S MOUNTAIN RD STE 1
FRUIT HEIGHTS UT
84037-2371
US

IV. Provider business mailing address

2067 E 1200 N
LAYTON UT
84040-7756
US

V. Phone/Fax

Practice location:
  • Phone: 801-510-5756
  • Fax:
Mailing address:
  • Phone: 801-510-5756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7196782-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: