Provider Demographics
NPI:1114670346
Name:BROOME, RACHEL (LPC, SEP, MS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BROOME
Suffix:
Gender:F
Credentials:LPC, SEP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 E OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6251
Mailing Address - Country:US
Mailing Address - Phone:520-508-6817
Mailing Address - Fax:
Practice Address - Street 1:2201 N CAMINO PRINCIPAL STE 165
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5334
Practice Address - Country:US
Practice Address - Phone:520-508-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20578101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty