Provider Demographics
NPI:1396208492
Name:COSTELLO, RACHEL E (PHD, MS, LPCC-S)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:E
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:PHD, MS, LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28059 US HIGHWAY 19 N STE 205
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2620
Mailing Address - Country:US
Mailing Address - Phone:727-205-2077
Mailing Address - Fax:
Practice Address - Street 1:1150 W RUSSELL RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-7025
Practice Address - Country:US
Practice Address - Phone:727-205-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500411101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor