Provider Demographics
NPI:1679110837
Name:LEAL, RACHEL RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:RENEE
Last Name:LEAL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19330 JESSE LN STE 280
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-5076
Mailing Address - Country:US
Mailing Address - Phone:951-387-4040
Mailing Address - Fax:
Practice Address - Street 1:19330 JESSE LN STE 280
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-5076
Practice Address - Country:US
Practice Address - Phone:951-387-4040
Practice Address - Fax:951-398-3144
Is Sole Proprietor?:No
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist