Provider Demographics
NPI:1831408731
Name:KOOL, RACHAEL
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:KOOL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:VAN ECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5873 BRAMALEA AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6418
Mailing Address - Country:US
Mailing Address - Phone:616-258-2590
Mailing Address - Fax:
Practice Address - Street 1:1401 60TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-7065
Practice Address - Country:US
Practice Address - Phone:616-258-2590
Practice Address - Fax:616-773-1264
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012123101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional