Provider Demographics
NPI:1508441320
Name:SHRYOCK, RACHEL MAE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MAE
Last Name:SHRYOCK
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N ARTHUR AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3105
Mailing Address - Country:US
Mailing Address - Phone:208-234-4673
Mailing Address - Fax:
Practice Address - Street 1:109 N ARTHUR AVE STE 203
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3105
Practice Address - Country:US
Practice Address - Phone:208-234-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health