Provider Demographics
NPI:1578219556
Name:STOTTS, RACHEL
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:
Last Name:STOTTS
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 1:1955 MARKET CENTER BLVD APT 2305
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3475
Mailing Address - Country:US
Mailing Address - Phone:414-551-1589
Mailing Address - Fax:
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 305
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4229
Practice Address - Country:US
Practice Address - Phone:469-518-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health