Provider Demographics
NPI:1588391296
Name:PAYNE, RACHEL (RBT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:PAYNE
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 1:3216 BALLARD LN
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-7200
Mailing Address - Country:US
Mailing Address - Phone:812-590-2157
Mailing Address - Fax:866-680-4566
Practice Address - Street 1:9943 FOREST GREEN BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5123
Practice Address - Country:US
Practice Address - Phone:502-830-9454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-22-215015106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician