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General NPI Number Information
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NPI Number | 1114691474
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Entity Type | Individual
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Provider Name | AMISTIC WILTZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/02/2021
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 4518 SHALLOW HILL CT
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City | HOUSTON
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State | TX
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Zip | 77084-7895
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Country | US
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Telephone | 346-327-4955
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Fax |
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Provider Business Mailing Address
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Address Line | 4518 SHALLOW HILL CT
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City | HOUSTON
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State | TX
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Zip | 77084-7895
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17427
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 61904
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License Number State | TX
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