Provider Demographics
NPI:1033279351
Name:RACHEL A KACSUR LCSW
Entity Type:Organization
Organization Name:RACHEL A KACSUR LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KACSUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:907-455-0250
Mailing Address - Street 1:PO BOX 70394
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0394
Mailing Address - Country:US
Mailing Address - Phone:907-455-0250
Mailing Address - Fax:907-455-0250
Practice Address - Street 1:535 2ND AVE
Practice Address - Street 2:SUITE 207B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4728
Practice Address - Country:US
Practice Address - Phone:907-455-0250
Practice Address - Fax:907-455-0250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty