Provider Demographics
NPI:1891405619
Name:FERNANDEZ, RAINEY ALEXANDRA (LPC)
Entity Type:Individual
Prefix:
First Name:RAINEY
Middle Name:ALEXANDRA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 W 5350 S
Mailing Address - Street 2:
Mailing Address - City:REXBURG
Mailing Address - State:ID
Mailing Address - Zip Code:83440-4415
Mailing Address - Country:US
Mailing Address - Phone:208-514-5288
Mailing Address - Fax:
Practice Address - Street 1:343 E 4TH N STE 201
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-6006
Practice Address - Country:US
Practice Address - Phone:208-243-9304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-9252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional