Walter William Mathis
Behavior Technician in Dearborn, MI. Individual provider (NPI-1).
NPI number1013756972
StatusActive
Last updated in NPPESMay 21, 2024
Details
- NPI
- 1013756972
- Entity type
- Individual (NPI-1)
- Name
- Walter William Mathis
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 21, 2024
- Certification date
- May 21, 2024
- Last updated
- May 21, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106S00000X | Behavior Technician | – | – | Yes |
Practice location
23663 Park StDearborn, MI 48124-2547
Phone 313-689-5188
Mailing address
23663 Park StDearborn, MI 48124-2547
Phone 313-689-5188
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