Provider Demographics
NPI:1487082012
Name:WALTERS, ELEANOR
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
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 1:720 W CHEYENNE AVE STE 50
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7844
Mailing Address - Country:US
Mailing Address - Phone:702-949-8622
Mailing Address - Fax:
Practice Address - Street 1:720 W CHEYENNE AVE STE 50
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7844
Practice Address - Country:US
Practice Address - Phone:702-949-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2017-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst