Healthcare Provider Details

I. General information

NPI: 1346181104
Provider Name (Legal Business Name): REACE A CORDER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2477 W MISSION TIMBER CIR
FLAGSTAFF AZ
86001-0776
US

IV. Provider business mailing address

2477 W MISSION TIMBER CIR
FLAGSTAFF AZ
86001-0776
US

V. Phone/Fax

Practice location:
  • Phone: 928-666-0759
  • Fax:
Mailing address:
  • Phone: 928-666-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-527066
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: