Provider Demographics
NPI:1609595453
Name:EVERETT, RACHEL M
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:EVERETT
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 1:11 MEADOWLAWN DR UNIT 14
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6262
Mailing Address - Country:US
Mailing Address - Phone:440-661-9986
Mailing Address - Fax:
Practice Address - Street 1:11 MEADOWLAWN DR UNIT 14
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6262
Practice Address - Country:US
Practice Address - Phone:440-661-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003492175T00000X
OHCDCA.183758101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist