Provider Demographics
NPI:1255893970
Name:SUTTON, TASCHA (RBT)
Entity type:Individual
Prefix:
First Name:TASCHA
Middle Name:
Last Name:SUTTON
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 1:3046 KENSINGTON RD APT 3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3576
Mailing Address - Country:US
Mailing Address - Phone:440-384-9934
Mailing Address - Fax:
Practice Address - Street 1:2323 WRENFORD RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3902
Practice Address - Country:US
Practice Address - Phone:440-384-9934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-19-82788106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician