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General NPI Number Information
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NPI Number | 1164725016
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Entity Type | Organization
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Legal Business Name | MICHAEL J. WOULAS, PH.D., INC
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 8891 BRIGHTON LANE SUITE 118
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City | BONITA SPRINGS
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State | FL
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Zip | 34135
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Country | US
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Telephone | 239-949-2415
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Fax | 239-390-1327
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Provider Business Mailing Address
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Address Line | 8891 BRIGHTON LN STE 118
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-7514
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Country | US
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Telephone | 239-949-2415
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Fax | 239-390-1327
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOHN WOULAS
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Credential | PH.D.
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Telephone | 239-949-2415
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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 | MT978
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License Number State | FL
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