Provider Demographics
NPI:1457174757
Name:BRACKETT, RACHEL CISNEROZ (LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:CISNEROZ
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 HILLTOP ST
Mailing Address - Street 2:
Mailing Address - City:BAIRD
Mailing Address - State:TX
Mailing Address - Zip Code:79504-2355
Mailing Address - Country:US
Mailing Address - Phone:817-235-2949
Mailing Address - Fax:
Practice Address - Street 1:1219 E SOUTH 11TH ST STE B-1
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4283
Practice Address - Country:US
Practice Address - Phone:325-266-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87693101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional