Healthcare Provider Details

I. General information

NPI: 1720343056
Provider Name (Legal Business Name): RACHAEL FRYREAR MA, CAC III
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 10/26/2025
Certification Date: 10/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 N LOGAN AVE
HAXTUN CO
80731-2563
US

IV. Provider business mailing address

PO BOX 113
HAXTUN CO
80731-0113
US

V. Phone/Fax

Practice location:
  • Phone: 970-580-7435
  • Fax: 970-580-7435
Mailing address:
  • Phone: 970-466-5659
  • Fax: 719-982-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC-6180
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0019645
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: