Individual
MR. MATTHEW WAYNE WEATHERFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
2815 EXCHANGE BLVD, 100, SOUTHLAKE, TX 76092-7514
(817) 479-9000
Mailing address
5001 PAR DR APT 3613, DENTON, TX 76208-6786
(940) 368-4597
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1119293
TX
Other
Enumeration date
12/29/2011
Last updated
12/29/2011
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