Provider Demographics
NPI:1154781607
Name:WILTZ, GREGORY JOSEPH II (BA)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:WILTZ
Suffix:II
Gender:M
Credentials:BA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:45 CYPRESS GROVE CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8938
Mailing Address - Country:US
Mailing Address - Phone:504-419-1717
Mailing Address - Fax:
Practice Address - Street 1:560 BELLE TERRE BLVD # A
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-1715
Practice Address - Country:US
Practice Address - Phone:985-652-0078
Practice Address - Fax:985-652-8360
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health