Provider Demographics
NPI:1770171555
Name:HENRY, RACHEL JILLIAN (RBT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JILLIAN
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 1:228 EMMANUEL WAY LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:KY
Mailing Address - Zip Code:40176-5037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:228 EMMANUEL WAY LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:KY
Practice Address - Zip Code:40176-5037
Practice Address - Country:US
Practice Address - Phone:310-560-9270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306394291OtherN/A