Provider Demographics
NPI:1407451933
Name:WALTERS, ALLEA (BCBA)
Entity Type:Individual
Prefix:
First Name:ALLEA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6471 AMERICAN EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-3252
Mailing Address - Country:US
Mailing Address - Phone:702-339-5565
Mailing Address - Fax:
Practice Address - Street 1:1091 S CIMARRON RD STE A4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2445
Practice Address - Country:US
Practice Address - Phone:702-339-5565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-20-142580106S00000X
NV1-22-62177103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician