Healthcare Provider Details

I. General information

NPI: 1255826319
Provider Name (Legal Business Name): RACHEL MARIE ALEXANDRA COSTELLA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 W CAMPBELL AVE
CAMPBELL CA
95008-1029
US

IV. Provider business mailing address

2010 EL CAMINO REAL
SANTA CLARA CA
95050-4051
US

V. Phone/Fax

Practice location:
  • Phone: 408-351-5753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109403
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number132716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: