Healthcare Provider Details

I. General information

NPI: 1942728621
Provider Name (Legal Business Name): MICHELLE WALLER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 HILLRISE DR
LAS CRUCES NM
88011-4701
US

IV. Provider business mailing address

505 N BRAND BLVD STE 1000
GLENDALE CA
91203-3924
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-9500
  • Fax:
Mailing address:
  • Phone: 855-295-3276
  • Fax: 818-241-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: