Provider Demographics
NPI:1245933928
Name:PERRY, RACHELLE D (RBT)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:D
Last Name:PERRY
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 1:109 WEDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-4419
Mailing Address - Country:US
Mailing Address - Phone:979-388-3390
Mailing Address - Fax:
Practice Address - Street 1:109 WEDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4419
Practice Address - Country:US
Practice Address - Phone:979-388-3390
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
TXBCBA557893106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician