Provider Demographics
NPI:1639386253
Name:REVES, RACHEL VALERA (MFT, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:VALERA
Last Name:REVES
Suffix:
Gender:F
Credentials:MFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 HUMPHREY RD
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-9257
Mailing Address - Country:US
Mailing Address - Phone:228-826-9034
Mailing Address - Fax:228-826-9034
Practice Address - Street 1:3500 CHICOT ST
Practice Address - Street 2:IST FLOOR
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-4316
Practice Address - Country:US
Practice Address - Phone:228-938-6869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1370101Y00000X
LA667106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist