| Doctor Name: | MR. GREGORY JOSEPH WILTZ |
| NPI Number: | 1154781607 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | BA |
| License Number: | |
| Business Practice Address: | 560 Belle Terre Blvd # A La Place, LA - 700681715 |
| Business Phone Number: | 9856520078 |
| Business Fax Number: | 9856528360 |
| Mailing Address: | 45 Cypress Grove Ct, NEW ORLEANS |
| State: | LA |
| Postal Code: | 701318938 |
| Phone Number: | 5044191717 |
| Fax Number: | |
| NPI Enumeration Date: | 02/25/2016 |
| NPI Last Update Date: | 02/25/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |