MEDICARE: WTJ AND ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	17-06-AD-747201	FL
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	1706AD747201	FL
3	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14560	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH
2	14555	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH
3	12003683	OTHER	FL	CAQH
4	12003631	OTHER	FL	CAQH

General Provider Information

NPI Number	:	1851620926
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WTJ AND ASSOCIATES

Provider Business Mailing Address
First Line	:	7551 WILES RD STE 105A
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2064
Country	:	US
Telephone Number	:	561-797-0480
Fax Number	:	754-240-4953

Provider Business Practice Location Address
First Line	:	7551 WILES RD STE 105A
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2064
Country	:	US
Telephone Number	:	561-797-0480
Fax Number	:	754-240-4953

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID D HAYWARD
Credential	:	LMHC MCAP
Telephone Number	:	561-797-0480

Provider Enumeration Date	:	12/18/2009
Last Update Date	:	12/23/2019

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1700237096 — DAVID DEXTER HAYWARD M.S., MCAP, LMHC
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Directions to “WTJ AND ASSOCIATES ” Practice Location

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