Provider Demographics
NPI:1215761853
Name:WEICHELT, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:WEICHELT
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 1:68 IROQUOIS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5502
Mailing Address - Country:US
Mailing Address - Phone:610-888-7168
Mailing Address - Fax:
Practice Address - Street 1:397 EAGLEVIEW BLVD STE 120
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1150
Practice Address - Country:US
Practice Address - Phone:610-422-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional