Provider Demographics
NPI:1336155514
Name:WIELAND, TRUITT RAY (LMSW)
Entity Type:Individual
Prefix:
First Name:TRUITT
Middle Name:RAY
Last Name:WIELAND
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28004 DELAFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2616
Mailing Address - Country:US
Mailing Address - Phone:830-438-2657
Mailing Address - Fax:
Practice Address - Street 1:28004 DELAFIELD DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2616
Practice Address - Country:US
Practice Address - Phone:830-438-2657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32962104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker