Provider Demographics
NPI:1225726557
Name:PAVLOV, RACHEL RENEE (LCDC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:RENEE
Last Name:PAVLOV
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5810 LONG PRAIRIE RD STE 700-127
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2584
Mailing Address - Country:US
Mailing Address - Phone:940-842-9516
Mailing Address - Fax:
Practice Address - Street 1:1338 LARAMIE PL
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2848
Practice Address - Country:US
Practice Address - Phone:682-553-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16312101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)