Provider Demographics
NPI:1932228558
Name:LABRECQUE, RACHAEL M (LMHC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:M
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 RED PINE LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5877
Mailing Address - Country:US
Mailing Address - Phone:904-377-6583
Mailing Address - Fax:
Practice Address - Street 1:4005 RED PINE LN
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5877
Practice Address - Country:US
Practice Address - Phone:904-826-0424
Practice Address - Fax:904-824-0421
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3961101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075753500Medicaid
FLMH3961OtherLMHC