Provider Demographics
NPI:1639330681
Name:YOUNG, RACHAEL LEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:LEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RACHAEL
Other - Middle Name:LEE
Other - Last Name:DERGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6804 NANCY ELLEN STREET
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:217-373-2430
Mailing Address - Fax:217-373-2444
Practice Address - Street 1:6010 AMARILLO BLVD WEST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-355-9703
Practice Address - Fax:217-373-2444
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0151291041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical