Provider Demographics
NPI:1629476403
Name:OTTESEN, RACHELLE (CMHC)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:OTTESEN
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 S 2800 E
Mailing Address - Street 2:
Mailing Address - City:NEW HARMONY
Mailing Address - State:UT
Mailing Address - Zip Code:84757-5115
Mailing Address - Country:US
Mailing Address - Phone:844-540-0357
Mailing Address - Fax:
Practice Address - Street 1:1947 S 2800 E
Practice Address - Street 2:
Practice Address - City:NEW HARMONY
Practice Address - State:UT
Practice Address - Zip Code:84757-5115
Practice Address - Country:US
Practice Address - Phone:435-634-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT102006816004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health