Basic Information
| Provider Information | |||||||||
| NPI: | 1972876126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.ED., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3100 PREMIER DR STE 234 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750632693 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727561222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3100 PREMIER DR STE 234 | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727561222 | ||||||||
| FaxNumber: | 4693740800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2012 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-17-28078 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1-17-28078 | 01 | BACB | OTHER |