Provider Demographics
NPI:1831657725
Name:WALTERS, RACHEL U
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:U
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 PENNSYLVANIA ST NE UNIT N3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5513
Mailing Address - Country:US
Mailing Address - Phone:505-573-2921
Mailing Address - Fax:
Practice Address - Street 1:1601 PENNSYLVANIA ST NE UNIT N3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5513
Practice Address - Country:US
Practice Address - Phone:505-573-2921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-09
Last Update Date:2019-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician