Provider Demographics
NPI:1922332055
Name:MCSPADDEN TARVER, RACHEL DIANE (MS, LMFT, RPT)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:DIANE
Last Name:MCSPADDEN TARVER
Suffix:
Gender:F
Credentials:MS, LMFT, RPT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:DIANE
Other - Last Name:POOLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:2925 MCMILLAN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6765
Mailing Address - Country:US
Mailing Address - Phone:805-748-0048
Mailing Address - Fax:
Practice Address - Street 1:2925 MCMILLAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6765
Practice Address - Country:US
Practice Address - Phone:805-748-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52657106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist