Provider Demographics
NPI:1982852513
Name:WYRTZEN, JOEL DANIEL (LPC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DANIEL
Last Name:WYRTZEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 BALCONES DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4272
Mailing Address - Country:US
Mailing Address - Phone:512-697-9613
Mailing Address - Fax:512-697-9613
Practice Address - Street 1:4409 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3313
Practice Address - Country:US
Practice Address - Phone:512-697-9613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962979-01Medicaid