Individual
JASON WILTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 COURT ST, PORT ALLEN, LA 70767-2747
(225) 245-9070
(225) 245-9073
Mailing address
2589 CREEK HOLLOW AVE, ZACHARY, LA 70791-2773
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/06/2020
Last updated
03/06/2020
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