Provider Demographics
NPI:1326467549
Name:WALTERS, DANIELLE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 WOOD HOLLOW DR APT 1122
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:314-276-4793
Mailing Address - Fax:
Practice Address - Street 1:3100 PREMIER DR
Practice Address - Street 2:234
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2661
Practice Address - Country:US
Practice Address - Phone:817-249-4807
Practice Address - Fax:817-249-2215
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-15178103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst