=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801100904
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANITA ROSE WELLER MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2010
-----------------------------------------------------
Last Update Date | 04/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 NE 4TH ST
-----------------------------------------------------
City | BEND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97701-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-904-5216
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7515 FALCON CREST DR # 200
-----------------------------------------------------
City | REDMOND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97756-5014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-904-5216
-----------------------------------------------------
Fax | 541-527-4347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | T1605
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------