Healthcare Provider Details

I. General information

NPI: 1174196406
Provider Name (Legal Business Name): RACHAEL ELIZABETH AUSTIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6933 W EMERALD ST
BOISE ID
83704-8616
US

IV. Provider business mailing address

3009 W KOOTENAI ST
BOISE ID
83705-2328
US

V. Phone/Fax

Practice location:
  • Phone: 208-321-0634
  • Fax:
Mailing address:
  • Phone: 208-794-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW-40840
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: