Provider Demographics
NPI:1225371917
Name:RACKI, MICHAEL R (LPC-MHSP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:RACKI
Suffix:
Gender:M
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4209
Mailing Address - Country:US
Mailing Address - Phone:615-487-3958
Mailing Address - Fax:
Practice Address - Street 1:122 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4209
Practice Address - Country:US
Practice Address - Phone:615-487-3958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3450OtherSTATE OF TENNESSEE