| Doctor Name: | JULIE WILTZ |
| NPI Number: | 1215396767 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 13317 |
| Business Practice Address: | 934 Coen Rd Rosharon, TX - 775833308 |
| Business Phone Number: | 7139334275 |
| Business Fax Number: | 2816748980 |
| Mailing Address: | 934 Coen Rd, ROSHARON |
| State: | TX |
| Postal Code: | 775833308 |
| Phone Number: | 7139334275 |
| Fax Number: | 2816748980 |
| NPI Enumeration Date: | 02/12/2016 |
| NPI Last Update Date: | 02/12/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 13317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |