Healthcare Provider Details

I. General information

NPI: 1124883764
Provider Name (Legal Business Name): RACHEL GRACE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 M ST
MODESTO CA
95354-0755
US

IV. Provider business mailing address

1101 M ST
MODESTO CA
95354-0755
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-9568
  • Fax:
Mailing address:
  • Phone: 303-502-0953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: