Provider Demographics
NPI:1487204426
Name:FORRESTER, TAHTIANNA (RBT)
Entity Type:Individual
Prefix:
First Name:TAHTIANNA
Middle Name:
Last Name:FORRESTER
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 1:2075 E WINDMILL LN STE 150
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-2085
Mailing Address - Country:US
Mailing Address - Phone:702-326-5996
Mailing Address - Fax:
Practice Address - Street 1:2075 E WINDMILL LN STE 150
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2085
Practice Address - Country:US
Practice Address - Phone:702-326-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT0428106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-17-36379OtherRBT CREDENTIAL