Doctor Name: | JUSTIN BLAKE WOLFF |
NPI Number: | 1568722247 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., LPC |
License Number: | 66289 |
Business Practice Address: | 101 Peaceful Ln Converse, TX - 781091007 |
Business Phone Number: | 2102489077 |
Business Fax Number: | 2109458489 |
Mailing Address: | 8407 Flint Rock Dr, BOERNE |
State: | TX |
Postal Code: | 780065534 |
Phone Number: | 2104752848 |
Fax Number: | |
NPI Enumeration Date: | 05/29/2012 |
NPI Last Update Date: | 05/29/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 66289 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |