Provider Demographics
NPI:1609176627
Name:FOOTH MORAN, RACHEL M (LMFT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:FOOTH MORAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:M
Other - Last Name:FOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:715 FLORIDA AVE S
Mailing Address - Street 2:307
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1719
Mailing Address - Country:US
Mailing Address - Phone:952-544-6806
Mailing Address - Fax:952-545-0098
Practice Address - Street 1:715 FLORIDA AVE S
Practice Address - Street 2:307
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1719
Practice Address - Country:US
Practice Address - Phone:952-544-6806
Practice Address - Fax:952-545-0098
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist