Healthcare Provider Details

I. General information

NPI: 1912490491
Provider Name (Legal Business Name): RACHEL CAROLINE CASEBOLT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W QUITMAN ST
HEBER SPRINGS AR
72543-3833
US

IV. Provider business mailing address

504 W QUITMAN ST
HEBER SPRINGS AR
72543-3833
US

V. Phone/Fax

Practice location:
  • Phone: 682-206-0202
  • Fax: 844-276-2121
Mailing address:
  • Phone: 682-206-0202
  • Fax: 844-276-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76546
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2202006
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: