Provider Demographics
NPI:1689179285
Name:WOHLWEND, BRIAN JAMES (BCBA, MED)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:WOHLWEND
Suffix:
Gender:M
Credentials:BCBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12205 WILDBROOK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-4111
Mailing Address - Country:US
Mailing Address - Phone:813-748-2477
Mailing Address - Fax:
Practice Address - Street 1:12205 WILDBROOK DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-4111
Practice Address - Country:US
Practice Address - Phone:813-748-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-12-10015103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-12-10015OtherBOARD CERTIFIED BEHAVIOR ANALYST