Healthcare Provider Details

I. General information

NPI: 1326467549
Provider Name (Legal Business Name): DANIELLE WALTERS M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PREMIER DR 234
IRVING TX
75063-2661
US

IV. Provider business mailing address

7117 WOOD HOLLOW DR APT 1122
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 817-249-4807
  • Fax: 817-249-2215
Mailing address:
  • Phone: 314-276-4793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-15178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: