Provider Demographics
NPI:1568131878
Name:WALTERS, LEXI TAYLOR (BCBA)
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:TAYLOR
Last Name:WALTERS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LEXI
Other - Middle Name:TAYLOR
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 29 1/4 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5276
Mailing Address - Country:US
Mailing Address - Phone:970-270-7204
Mailing Address - Fax:
Practice Address - Street 1:2591 LEGACY WAY
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81503-1789
Practice Address - Country:US
Practice Address - Phone:970-549-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-53132103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst