Provider Demographics
NPI:1083086052
Name:WFR BEHAVIORAL ONE, LLC
Entity Type:Organization
Organization Name:WFR BEHAVIORAL ONE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SCHOOL PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, BCBA
Authorized Official - Phone:205-233-1414
Mailing Address - Street 1:1025 MONTGOMERY HWY
Mailing Address - Street 2:SUITE #214
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2845
Mailing Address - Country:US
Mailing Address - Phone:205-233-1414
Mailing Address - Fax:205-822-2732
Practice Address - Street 1:1025 MONTGOMERY HWY
Practice Address - Street 2:SUITE #214
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-2845
Practice Address - Country:US
Practice Address - Phone:205-233-1414
Practice Address - Fax:205-822-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-15-19295103K00000X
ALWXR-01058632103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1588615918Medicaid