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General NPI Number Information
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NPI Number | 1083086052
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Entity Type | Organization
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Legal Business Name | WFR BEHAVIORAL ONE, LLC
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Dates
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Enumeration Date | 10/29/2015
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Last Update Date | 10/29/2015
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Provider Practice Location Address
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Address Line | 1025 MONTGOMERY HWY SUITE #214
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City | VESTAVIA
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State | AL
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Zip | 35216-2845
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Country | US
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Telephone | 205-233-1414
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Fax | 205-822-2732
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Provider Business Mailing Address
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Address Line | 1025 MONTGOMERY HWY SUITE #214
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City | VESTAVIA
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State | AL
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Zip | 35216-2845
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Country | US
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Telephone | 205-233-1414
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Fax | 205-822-2732
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Authorized Official
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Title or Position | OWNER/SCHOOL PSYCHOLOGIST
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Name | MR. WILLIAM RICHARDSON
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Credential | ED.S., BCBA
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Telephone | 205-233-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | WXR-01058632
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-15-19295
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License Number State | AL
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