Provider Demographics
NPI:1609563006
Name:GREENWELL, RACHEL (T-CADC, TCM, APSS)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:GREENWELL
Suffix:
Gender:F
Credentials:T-CADC, TCM, APSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-1484
Mailing Address - Country:US
Mailing Address - Phone:502-222-2389
Mailing Address - Fax:
Practice Address - Street 1:134 CATHY WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-3286
Practice Address - Country:US
Practice Address - Phone:502-381-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY202232171M00000X
KY279087175T00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist