Healthcare Provider Details

I. General information

NPI: 1689205742
Provider Name (Legal Business Name): RACHAEL ERIN MARTIN JONES LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHAEL ERIN MARTIN

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 W GLENN LN
MOUNT PROSPECT IL
60056-4062
US

IV. Provider business mailing address

1227 W GLENN LN
MOUNT PROSPECT IL
60056-4062
US

V. Phone/Fax

Practice location:
  • Phone: 847-707-3195
  • Fax:
Mailing address:
  • Phone: 847-707-3195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number166001480
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number208.000793
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: