Provider Demographics
NPI:1437827177
Name:WALLS, ANNESE BRIANNA (MED, BCBA, LBS)
Entity Type:Individual
Prefix:
First Name:ANNESE
Middle Name:BRIANNA
Last Name:WALLS
Suffix:
Gender:F
Credentials:MED, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MANHEIM PIKE STE 2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3064
Mailing Address - Country:US
Mailing Address - Phone:717-945-6491
Mailing Address - Fax:
Practice Address - Street 1:1630 MANHEIM PIKE STE 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3064
Practice Address - Country:US
Practice Address - Phone:717-945-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-17-28824103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst