Basic Information
| Provider Information | |||||||||
| NPI: | 1326467549 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | DANIELLE | ||||||||
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| Credential: | M.S., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7117 WOOD HOLLOW DR APT 1122 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142764793 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3100 PREMIER DR | ||||||||
| Address2: | 234 | ||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632661 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172494807 | ||||||||
| FaxNumber: | 8172492215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2014 | ||||||||
| LastUpdateDate: | 12/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-14-15178 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.