Provider Demographics
NPI:1578780110
Name:RICHARDSON, RACHEL ELLEN (BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:ELLEN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BA PSYCHOLOGY
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:ELLEN
Other - Last Name:FOSTER-WEHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA PSYCHOLOGY
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-0852
Mailing Address - Country:US
Mailing Address - Phone:831-419-1065
Mailing Address - Fax:
Practice Address - Street 1:2115 7TH AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1663
Practice Address - Country:US
Practice Address - Phone:831-466-9307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor