MEDICARE: CIERRA PATRICIA WALLING 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
1	103K00000X	Behavior Analyst	BEH-000527	AZ
2	106S00000X	Behavior Technician	60771903	WA
3	103K00000X	Behavior Analyst	LBA0528	NV

General Provider Information

NPI Number	:	1528574365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIERRA PATRICIA WALLING BCBA

Provider Business Mailing Address
First Line	:	1000 N GREEN VALLEY PKWY # 440-604
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-6170
Country	:	US
Telephone Number	:	702-900-7179
Fax Number	:

Provider Business Practice Location Address
First Line	:	3037 E WARM SPRINGS RD STE 200-13
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3758
Country	:	US
Telephone Number	:	702-900-7179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2017
Last Update Date	:	07/28/2023

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