Provider Demographics
NPI:1750916425
Name:MARTIN, RACHEL (PSY S, NCSP)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PSY S, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 EAKIN RD APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-5801
Mailing Address - Country:US
Mailing Address - Phone:330-242-2985
Mailing Address - Fax:
Practice Address - Street 1:20800 WESTGATE PROFESSIONAL CENTER #200,
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126
Practice Address - Country:US
Practice Address - Phone:440-333-4949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool