Provider Demographics
NPI:1639470156
Name:HARRY, RACHEL L (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:L
Last Name:HARRY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 NEW PINERY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1110
Mailing Address - Country:US
Mailing Address - Phone:608-742-5020
Mailing Address - Fax:608-742-3641
Practice Address - Street 1:2639 NEW PINERY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1110
Practice Address - Country:US
Practice Address - Phone:608-742-5020
Practice Address - Fax:608-742-3641
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4466-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health