Provider Demographics
NPI:1659877108
Name:MITCHELL, RACHEL (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 N MAIN ST STE 129
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4609
Mailing Address - Country:US
Mailing Address - Phone:925-286-8898
Mailing Address - Fax:
Practice Address - Street 1:8274 STATION VILLAGE LN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6505
Practice Address - Country:US
Practice Address - Phone:925-286-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2022-04-18
Deactivation Date:2022-02-02
Deactivation Code:
Reactivation Date:2022-04-15
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-38215106S00000X
CA128627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician