Provider Demographics
NPI:1316585193
Name:COOK, RACHELLE J (LSW)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:J
Last Name:COOK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N PIKE ST APT C
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:OH
Mailing Address - Zip Code:45302-8683
Mailing Address - Country:US
Mailing Address - Phone:937-726-6543
Mailing Address - Fax:
Practice Address - Street 1:1025 FAIR RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-8947
Practice Address - Country:US
Practice Address - Phone:937-492-1352
Practice Address - Fax:937-492-1353
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0901034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.0901034OtherCOUNSELOR, SOCIAL WORKER & MFT BOARD
OH0383251Medicaid