Provider Demographics
NPI:1396575148
Name:CARSTENS, RAELEN (MA, PLPC)
Entity type:Individual
Prefix:
First Name:RAELEN
Middle Name:
Last Name:CARSTENS
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:RAELEN
Other - Middle Name:
Other - Last Name:GIPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 COUNTY ROAD 213
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-8998
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:411 CENTRAL METHODIST SQUARE
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248
Practice Address - Country:US
Practice Address - Phone:660-248-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023042326101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health