Provider Demographics
NPI:1174122303
Name:ALLRED, RACHEL ELLEN (CSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELLEN
Last Name:ALLRED
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:SHELLEE
Other - Middle Name:E
Other - Last Name:ALLRED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1295
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-1295
Mailing Address - Country:US
Mailing Address - Phone:435-749-1530
Mailing Address - Fax:
Practice Address - Street 1:128 N 100 W STE 5
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2429
Practice Address - Country:US
Practice Address - Phone:435-749-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9494135-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical