MEDICARE: JOEL DANIEL WYRTZEN LPC

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	101YP2500X	Professional Counselor	62480	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982852513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL DANIEL WYRTZEN LPC

Provider Business Mailing Address
First Line	:	5758 BALCONES DR STE 101
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-4272
Country	:	US
Telephone Number	:	512-697-9613
Fax Number	:	512-697-9613

Provider Business Practice Location Address
First Line	:	4409 MEDICAL PKWY
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-3313
Country	:	US
Telephone Number	:	512-697-9613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	04/02/2024

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