Provider Demographics
NPI:1023715612
Name:WALSH, SAMANTHA LEANNA (BCBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEANNA
Last Name:WALSH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5731 JACKSON ST STE B&C
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7022
Mailing Address - Country:US
Mailing Address - Phone:318-704-6470
Mailing Address - Fax:888-432-2814
Practice Address - Street 1:5731 JACKSON ST STE B&C
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-7022
Practice Address - Country:US
Practice Address - Phone:318-704-6470
Practice Address - Fax:888-432-2814
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst