Organization
WIESNER ABA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR WIESNER BCBA (OWNER, FOUNDER)
(936) 554-1616
Entity
Organization
Contact information
Practice address
2990 BLACKBURN ST, APT 3164, DALLAS, TX 75204-3113
(936) 554-1616
Mailing address
2990 BLACKBURN ST, APT 3164, DALLAS, TX 75204-3113
(936) 554-1616
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
TX
252Y00000X
Early Intervention Provider Agency
—
TX
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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