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NPI Code Detail

MEDICARE: CARLEY WALTENBURG M.S., BCBA

MEDICARE: CARLEY WALTENBURG M.S., BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1023493970
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLEY WALTENBURG M.S., BCBA
Provider Business Mailing Address
First Line : 7801 MESQUITE BEND DR STE 105
Second Line :
City : IRVING
State : TX
Zip : 75063-6043
Country : US
Telephone Number : 972-672-6717
Fax Number :
Provider Business Practice Location Address
First Line : 7801 MESQUITE BEND DR STE 105
Second Line :
City : IRVING
State : TX
Zip : 75063-6043
Country : US
Telephone Number : 972-672-6717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2015
Last Update Date : 04/08/2024

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