Provider Demographics
NPI:1083317531
Name:RALEY, BRETT (RBT)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:RALEY
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 AIRPORT BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8622
Mailing Address - Country:US
Mailing Address - Phone:850-889-5803
Mailing Address - Fax:
Practice Address - Street 1:1100 AIRPORT BLVD STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8622
Practice Address - Country:US
Practice Address - Phone:850-889-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-257805106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician