Provider Demographics
NPI:1841509528
Name:CARLSON, RACHEL (QMHP, MSW)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CARLSON
Suffix:
Gender:F
Credentials:QMHP, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SW 5TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-2205
Mailing Address - Country:US
Mailing Address - Phone:503-988-3747
Mailing Address - Fax:503-988-4898
Practice Address - Street 1:421 SW 5TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2205
Practice Address - Country:US
Practice Address - Phone:503-988-3747
Practice Address - Fax:503-988-4898
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health