Provider Demographics
NPI:1164725016
Name:MICHAEL J. WOULAS, PH.D., INC
Entity Type:Organization
Organization Name:MICHAEL J. WOULAS, PH.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WOULAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-949-2415
Mailing Address - Street 1:8891 BRIGHTON LN STE 118
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7514
Mailing Address - Country:US
Mailing Address - Phone:239-949-2415
Mailing Address - Fax:239-390-1327
Practice Address - Street 1:8891 BRIGHTON LANE SUITE 118
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-949-2415
Practice Address - Fax:239-390-1327
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICHAEL J. WOULAS, PH.D. INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT978103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty