Provider Demographics
NPI:1417576943
Name:RICKEN, RACHELLE ROSE
Entity Type:Individual
Prefix:MS
First Name:RACHELLE
Middle Name:ROSE
Last Name:RICKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 NEW DAWN CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6860
Mailing Address - Country:US
Mailing Address - Phone:530-520-3087
Mailing Address - Fax:
Practice Address - Street 1:2430 BIRD ST
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-4908
Practice Address - Country:US
Practice Address - Phone:530-538-7277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94043101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty