Healthcare Provider Details

I. General information

NPI: 1801284781
Provider Name (Legal Business Name): MICHAEL WURTH MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9215 RAINBOW CRK
SAN ANTONIO TX
78245-1481
US

IV. Provider business mailing address

9215 RAINBOW CRK
SAN ANTONIO TX
78245-1481
US

V. Phone/Fax

Practice location:
  • Phone: 210-620-7700
  • Fax:
Mailing address:
  • Phone: 210-620-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12744
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: