Provider Demographics
NPI:1558891515
Name:CLOUD, RACHAEL (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:CLOUD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-2149
Mailing Address - Country:US
Mailing Address - Phone:219-728-1638
Mailing Address - Fax:219-728-1639
Practice Address - Street 1:1008 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-2149
Practice Address - Country:US
Practice Address - Phone:219-728-1638
Practice Address - Fax:219-728-1639
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002977A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health