Provider Demographics
NPI:1255636791
Name:MOCK, RACHEL ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:MOCK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:VANDERIET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:FL
Mailing Address - Zip Code:32343-0533
Mailing Address - Country:US
Mailing Address - Phone:850-812-9017
Mailing Address - Fax:850-800-9922
Practice Address - Street 1:175 GEDDIE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304-6621
Practice Address - Country:US
Practice Address - Phone:850-812-9017
Practice Address - Fax:850-800-9922
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
FLMH12279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor