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General NPI Number Information
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NPI Number | 1255989026
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Entity Type | Individual
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Provider Name | JUSTIN MICHAEL WERTZ BCBA
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Gender | Male
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Dates
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Enumeration Date | 08/26/2019
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2207 COTTONDALE LN STE 2
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City | LITTLE ROCK
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State | AR
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Zip | 72202-2018
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Country | US
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Telephone | 501-539-3553
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 ADDYBROOK ST
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City | CONWAY
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State | AR
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Zip | 72032-5838
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Country | US
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Telephone | 501-514-2033
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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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 | 1-21-55896
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License Number State |
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