Provider Demographics
NPI:1427268309
Name:PRATHER, WALTER WITTY JR (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WITTY
Last Name:PRATHER
Suffix:JR
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 N HANNON HILL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-8941
Mailing Address - Country:US
Mailing Address - Phone:850-894-2103
Mailing Address - Fax:850-894-2105
Practice Address - Street 1:2887 N HANNON HILL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-8941
Practice Address - Country:US
Practice Address - Phone:850-894-2103
Practice Address - Fax:850-894-2105
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 2445101YM0800X
FLMT 1871106H00000X
FL1-01-0566103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7610441 00Medicaid