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General NPI Number Information
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NPI Number | 1629505573
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Entity Type | Individual
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Provider Name | VERNON ARCHIE WIGGINS III BCBA, LPC, LBA, LMHC
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 11035 FOREST GLN
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City | BEAUMONT
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State | TX
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Zip | 77713-9003
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Country | US
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Telephone | 210-323-3153
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Fax |
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Provider Business Mailing Address
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Address Line | 11035 FOREST GLN
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City | BEAUMONT
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State | TX
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Zip | 77713-9003
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Country | US
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Telephone | 210-323-3153
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 79828
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License Number State | TX
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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 | 1479
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-17593
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT034888
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH61560733
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License Number State | WA
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