Provider Demographics
NPI:1457907750
Name:JOHNSON, RACHAEL ELOISA (RBT)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:ELOISA
Last Name:JOHNSON
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 1:140 UWAPO RD APT 23-106
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7417
Mailing Address - Country:US
Mailing Address - Phone:210-276-1701
Mailing Address - Fax:
Practice Address - Street 1:140 UWAPO RD APT 23-106
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7417
Practice Address - Country:US
Practice Address - Phone:210-276-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-19-93340106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician