Provider Demographics
NPI:1801450614
Name:MCCOACH, RACHEL K (MA, LCAT, LMHC, RDT)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:K
Last Name:MCCOACH
Suffix:
Gender:F
Credentials:MA, LCAT, LMHC, RDT
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:K
Other - Last Name:LEE SOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LCAT, LMHC, RDT
Mailing Address - Street 1:460 ENA RD STE 505
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1774
Mailing Address - Country:US
Mailing Address - Phone:808-219-4384
Mailing Address - Fax:
Practice Address - Street 1:460 ENA RD STE 5055
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1779
Practice Address - Country:US
Practice Address - Phone:917-267-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002028101200000X
HIMHC-590101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101200000XBehavioral Health & Social Service ProvidersDrama Therapist