Provider Demographics
NPI:1023493970
Name:WALTENBURG, CARLEY (MS, BCBA)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:WALTENBURG
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 1:7801 MESQUITE BEND DR STE 105
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-6043
Mailing Address - Country:US
Mailing Address - Phone:972-672-6717
Mailing Address - Fax:
Practice Address - Street 1:7801 MESQUITE BEND DR STE 105
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-6043
Practice Address - Country:US
Practice Address - Phone:972-672-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst