Healthcare Provider Details

I. General information

NPI: 1962830273
Provider Name (Legal Business Name): RACHEL YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 W BELLTOWER DR
MERIDIAN ID
83646-4882
US

IV. Provider business mailing address

3144 W BELLTOWER DR
MERIDIAN ID
83646-4882
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-7443
  • Fax: 208-314-0726
Mailing address:
  • Phone: 208-466-7443
  • Fax: 208-314-0726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6825
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6782
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77455
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: