Provider Demographics
NPI:1962830273
Name:YOUNG, RACHEL
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3144 W BELLTOWER DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-4882
Mailing Address - Country:US
Mailing Address - Phone:208-466-7443
Mailing Address - Fax:208-314-0726
Practice Address - Street 1:3144 W BELLTOWER DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-4882
Practice Address - Country:US
Practice Address - Phone:208-466-7443
Practice Address - Fax:208-314-0726
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6825106H00000X
ID6782106H00000X
CA77455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist