Provider Demographics
NPI:1255005294
Name:WALTERS, GABRIELLA R (RBT)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 S GESSNER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-5284
Mailing Address - Country:US
Mailing Address - Phone:713-782-1330
Mailing Address - Fax:
Practice Address - Street 1:3500 S GESSNER RD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-5284
Practice Address - Country:US
Practice Address - Phone:713-782-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-164989106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXRBT-21-164989OtherRBT