Provider Demographics
NPI:1396631578
Name:SU, RACHEL (RBT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:SU
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 1:2925 AUTUMN HAZE LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-0659
Mailing Address - Country:US
Mailing Address - Phone:702-945-9112
Mailing Address - Fax:
Practice Address - Street 1:8072 W SAHARA AVE STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1974
Practice Address - Country:US
Practice Address - Phone:725-205-3628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician