Provider Demographics
NPI:1609229269
Name:AUGUSTUS, RACHEL (MS,)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:AUGUSTUS
Suffix:
Gender:F
Credentials:MS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 W 1330 S
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-2233
Mailing Address - Country:US
Mailing Address - Phone:208-989-0961
Mailing Address - Fax:
Practice Address - Street 1:131 S 700 E STE 102
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2485
Practice Address - Country:US
Practice Address - Phone:702-329-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2020-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10840018-3902106H00000X
NV01393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist