Provider Demographics
NPI:1205353091
Name:TETREAULT, RACHELLE RENAE (LAC)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:RENAE
Last Name:TETREAULT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2706 N POWNAL RD
Mailing Address - Street 2:
Mailing Address - City:POWNAL
Mailing Address - State:VT
Mailing Address - Zip Code:05261-9625
Mailing Address - Country:US
Mailing Address - Phone:772-353-1397
Mailing Address - Fax:
Practice Address - Street 1:63 SPRING ST STE F
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2889
Practice Address - Country:US
Practice Address - Phone:772-353-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician