Active NPI
Michelle Walters
- Behavior Analyst
- Indianapolis, IN
National Provider Identifier
1083978548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 0125063
- Practice address
- 7128 Sea Pine Dr
Indianapolis, IN 46250-4138 - Phone
- (630) 205-4356
- Fax
- (317) 842-4428
- NPI assigned
- Jun 29, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 0125063 | IN | Primary |
Addresses
Primary practice location
7128 Sea Pine Dr
Indianapolis, IN 46250-4138
Mailing address
7128 Sea Pine Dr
Indianapolis, IN 46250-4138
Phone (630) 205-4356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0125063 | IN | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554336000000",
"number": "1083978548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7128 SEA PINE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462504138",
"telephone_number": "630-205-4356",
"fax_number": "317-842-4428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7128 SEA PINE DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462504138",
"telephone_number": "630-205-4356",
"fax_number": "317-842-4428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTERS",
"first_name": "MICHELLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-06-29",
"last_updated": "2019-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "IN",
"license": "0125063",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.