Provider Demographics
NPI:1508511635
Name:WERTSBAUGH, COLTON JOHN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:COLTON
Middle Name:JOHN
Last Name:WERTSBAUGH
Suffix:
Gender:M
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 CORNERSTONE ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5346
Mailing Address - Country:US
Mailing Address - Phone:434-214-8112
Mailing Address - Fax:434-534-3034
Practice Address - Street 1:118 CORNERSTONE ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5346
Practice Address - Country:US
Practice Address - Phone:434-214-8112
Practice Address - Fax:434-534-3034
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0133002384103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst