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General NPI Number Information
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NPI Number | 1467268607
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Entity Type | Individual
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Provider Name | ERIC DANIEL RATHBURN
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Gender | Male
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 824 N 99TH AVE STE 107
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City | AVONDALE
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State | AZ
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Zip | 85323-5327
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Country | US
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Telephone | 602-540-1271
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Fax |
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Provider Business Mailing Address
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Address Line | 824 N 99TH AVE STE 107
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City | AVONDALE
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State | AZ
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Zip | 85323-5327
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Country | US
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Telephone | 602-540-1271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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