Healthcare Provider Details

I. General information

NPI: 1033013297
Provider Name (Legal Business Name): PAMELA RACHEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E NORTHWEST HWY
ARLINGTON HEIGHTS IL
60004-6944
US

IV. Provider business mailing address

111 S MORGAN ST APT 819
CHICAGO IL
60607-2736
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-0976
  • Fax:
Mailing address:
  • Phone: 210-296-1487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011658
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: