Provider Demographics
NPI:1649717612
Name:MARSHALL, RACHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92661-0540
Mailing Address - Country:US
Mailing Address - Phone:714-922-5371
Mailing Address - Fax:
Practice Address - Street 1:1107 E CHAPMAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2101
Practice Address - Country:US
Practice Address - Phone:714-922-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist