Individual
MICHAEL BOB WALLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
400 AIRPORT RD, TERRELL, TX 75160-4302
(972) 388-2000
Mailing address
3204 AUBURN DR, ROWLETT, TX 75088-6647
(903) 258-1188
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-25-50389
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1596
INSURANCE
TX
Enumeration date
06/18/2021
Last updated
06/18/2021
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