Provider Demographics
NPI:1730671231
Name:HENRY, AMBER (RBT)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:HENRY
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 1:6897 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1640
Mailing Address - Country:US
Mailing Address - Phone:888-505-1637
Mailing Address - Fax:888-501-0472
Practice Address - Street 1:6897 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1640
Practice Address - Country:US
Practice Address - Phone:888-505-1637
Practice Address - Fax:888-501-0472
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-18-56060106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty