Petty, Breelyn Raine

Petty, Breelyn Raine is an individual health care provider with primary practice located at 5220 N Dysart Rd Bldg C , Litchfield Park AZ 85340-3045. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavior Technician, Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Petty, Breelyn Raine can be contacted via phone (623) 244-9179.

Contact Information

Primary practice address
5220 N Dysart Rd Bldg C Litchfield Park AZ 85340-3045
Phone: (623) 244-9179
Fax: (317) 520-8200
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavior Technician 106S00000X RBT-19-108925 Arizona
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X BEH-000788 Arizona

Profile Details

NPI number 1285243485
LBN Legal business name Petty, Breelyn Raine
Credentials MS, BCBA
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 24th, 2020
Last updated Aug 26th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285243485 NPPES
Other 1-21-50507 BCBA CERTIFICATE

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