Provider Demographics
NPI:1760160238
Name:ROUTIN, RACHEL MARIE (MS, TLLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARIE
Last Name:ROUTIN
Suffix:
Gender:F
Credentials:MS, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13360 GREENVIEW DR APT 205
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3428
Mailing Address - Country:US
Mailing Address - Phone:734-673-3558
Mailing Address - Fax:
Practice Address - Street 1:511 BEAUBIEN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-4309
Practice Address - Country:US
Practice Address - Phone:313-444-7084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009643103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist