Provider Demographics
NPI:1750023248
Name:KING, RACHAEL DELORES
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:DELORES
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 BOOTSPUR DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2450
Mailing Address - Country:US
Mailing Address - Phone:702-497-0331
Mailing Address - Fax:
Practice Address - Street 1:1058 BOOTSPUR DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-2450
Practice Address - Country:US
Practice Address - Phone:702-497-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician