Provider Demographics
NPI:1114452430
Name:KESSELL, AUDREY (RBT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:KESSELL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6628 SKY POINTE DR
Mailing Address - Street 2:#114
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-4070
Mailing Address - Country:US
Mailing Address - Phone:702-704-5112
Mailing Address - Fax:186-663-3925
Practice Address - Street 1:6628 SKY POINTE DR
Practice Address - Street 2:#114
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-4070
Practice Address - Country:US
Practice Address - Phone:702-704-5112
Practice Address - Fax:186-663-3925
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-17-31807106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVRBT-17-31807OtherBACB