Provider Demographics
NPI:1780829291
Name:ENSOM, RACHAEL CATHERINE (LICENSED MFT)
Entity Type:Individual
Prefix:MISS
First Name:RACHAEL
Middle Name:CATHERINE
Last Name:ENSOM
Suffix:
Gender:F
Credentials:LICENSED MFT
Other - Prefix:MISS
Other - First Name:RACHAEL
Other - Middle Name:CATHERINE
Other - Last Name:ENSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:6051 N FRESNO ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5280
Mailing Address - Country:US
Mailing Address - Phone:559-246-7764
Mailing Address - Fax:
Practice Address - Street 1:6051 N FRESNO ST STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-246-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109879106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist