Provider Demographics
NPI:1316482706
Name:ARRIETA, REBE NICOLE (RBT)
Entity type:Individual
Prefix:MRS
First Name:REBE
Middle Name:NICOLE
Last Name:ARRIETA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MISS
Other - First Name:REBE
Other - Middle Name:NICOLE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4779 BALBOA RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-6349
Mailing Address - Country:US
Mailing Address - Phone:847-912-9708
Mailing Address - Fax:
Practice Address - Street 1:171 STATE HIGHWAY 83 UNIT A101
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-7427
Practice Address - Country:US
Practice Address - Phone:850-585-9189
Practice Address - Fax:850-951-0898
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-21092106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician