Provider Demographics
NPI:1629505573
Name:WIGGINS, VERNON ARCHIE III (BCBA, LPC, LBA, LMHC)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:ARCHIE
Last Name:WIGGINS
Suffix:III
Gender:M
Credentials:BCBA, LPC, LBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11035 FOREST GLN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-9003
Mailing Address - Country:US
Mailing Address - Phone:210-323-3153
Mailing Address - Fax:
Practice Address - Street 1:11035 FOREST GLN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77713-9003
Practice Address - Country:US
Practice Address - Phone:210-323-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79828101YP2500X
TX1479103K00000X
CO1-14-17593103K00000X
TXMT034888225700000X
WALH61560733101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA101YM0800XOtherLICENSED MENTAL HEALTH COUNSELOR