Provider Demographics
NPI:1144779745
Name:JEAN-LOUIS, RACHELLE
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:JEAN-LOUIS
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 1:2868 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-2497
Mailing Address - Country:US
Mailing Address - Phone:561-350-5073
Mailing Address - Fax:
Practice Address - Street 1:1700 BANKS RD
Practice Address - Street 2:SUITE 50-P
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7719
Practice Address - Country:US
Practice Address - Phone:954-507-7219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10376101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health