Provider Demographics
NPI:1104378488
Name:LUPERCIO, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:LUPERCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 GLENVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1116
Mailing Address - Country:US
Mailing Address - Phone:512-228-8858
Mailing Address - Fax:
Practice Address - Street 1:13803 ANN PL
Practice Address - Street 2:C/O SOL HEALING & WELLNESS CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-7702
Practice Address - Country:US
Practice Address - Phone:888-593-2081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201861106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201861OtherLICENSE MARRIAGE & FAMILY THERAPIST