Provider Demographics
NPI:1922492115
Name:WAHLQUIST, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WAHLQUIST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11820 CYPRESS CORNER LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-1132
Mailing Address - Country:US
Mailing Address - Phone:281-894-1423
Mailing Address - Fax:
Practice Address - Street 1:12110 HUFFMEISTER RD.
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429
Practice Address - Country:US
Practice Address - Phone:281-894-1423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X
TX3522103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst