Provider Demographics
NPI:1013681758
Name:VANDZURA, JOE EVERETT (RBT)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:EVERETT
Last Name:VANDZURA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DER FLUGPLATZ
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8661
Mailing Address - Country:US
Mailing Address - Phone:954-298-1359
Mailing Address - Fax:830-755-6525
Practice Address - Street 1:12 DER FLUGPLATZ
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8661
Practice Address - Country:US
Practice Address - Phone:954-298-1359
Practice Address - Fax:830-755-6525
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-20-136434106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician