Provider Demographics
NPI:1497361323
Name:FAZEKAS, RACHEL (LMFT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FAZEKAS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 VIA CANDREJO
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-6608
Mailing Address - Country:US
Mailing Address - Phone:949-701-9771
Mailing Address - Fax:
Practice Address - Street 1:7035 VIA CANDREJO
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-6608
Practice Address - Country:US
Practice Address - Phone:949-701-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist