Healthcare Provider Details

I. General information

NPI: 1891369849
Provider Name (Legal Business Name): MRS. RACHEL BETH SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2021
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14809 N 73RD ST STE 204
SCOTTSDALE AZ
85260-3104
US

IV. Provider business mailing address

14809 N 73RD ST STE 204
SCOTTSDALE AZ
85260-3104
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-2303
  • Fax:
Mailing address:
  • Phone: 480-626-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-17553
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-17553
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: