Provider Demographics
NPI:1861007916
Name:RASMUSSEN, RACHEL M (MED, LMHCA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:M
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:MED, LMHCA
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:J
Other - Last Name:WILDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LMHCA
Mailing Address - Street 1:282084 US HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-9331
Mailing Address - Country:US
Mailing Address - Phone:360-531-1115
Mailing Address - Fax:
Practice Address - Street 1:282084 US HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-9331
Practice Address - Country:US
Practice Address - Phone:360-531-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61083275101YM0800X
ID7651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health