Provider Demographics
NPI:1558682930
Name:SMITH, RACHELLE D (PHD, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 OVERLAND PLZ
Mailing Address - Street 2:
Mailing Address - City:OVERLAND
Mailing Address - State:MO
Mailing Address - Zip Code:63114-6123
Mailing Address - Country:US
Mailing Address - Phone:314-744-9027
Mailing Address - Fax:314-571-9698
Practice Address - Street 1:9100 OVERLAND PLZ
Practice Address - Street 2:
Practice Address - City:OVERLAND
Practice Address - State:MO
Practice Address - Zip Code:63114-6123
Practice Address - Country:US
Practice Address - Phone:314-744-9027
Practice Address - Fax:314-571-9698
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010009689101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional