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General NPI Number Information
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NPI Number | 1073882536
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Entity Type | Individual
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Provider Name | MATTHEW WAYNE WEATHERFORD BCBA
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Gender | Male
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 2815 EXCHANGE BLVD 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-7514
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Country | US
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Telephone | 817-479-9000
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Fax |
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Provider Business Mailing Address
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Address Line | 5001 PAR DR APT 3613
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City | DENTON
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State | TX
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Zip | 76208-6786
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Country | US
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Telephone | 940-368-4597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1119293
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License Number State | TX
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