Healthcare Provider Details

I. General information

NPI: 1174217103
Provider Name (Legal Business Name): RACHEL CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/05/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CORSON AVE
MODESTO CA
95350-5408
US

IV. Provider business mailing address

3824 TROON PL
MODESTO CA
95357-1365
US

V. Phone/Fax

Practice location:
  • Phone: 209-988-5979
  • Fax:
Mailing address:
  • Phone: 209-281-4952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: