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General NPI Number Information
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NPI Number | 1447523162
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Entity Type | Individual
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Provider Name | JOSEPH LEE WALDRON BCABA
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Gender | Male
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 265 E LULLWOOD AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78212-5268
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Country | US
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Telephone | 210-680-8737
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 GATEWAY BLVD APT. 1522
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City | LIVE OAK
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State | TX
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Zip | 78233-2671
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Country | US
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Telephone | 210-827-3462
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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 | 0-11-4365
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License Number State |
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