Healthcare Provider Details

I. General information

NPI: 1720657455
Provider Name (Legal Business Name): RACHEL SMITH MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 S EAST ST
INDIANAPOLIS IN
46227-7112
US

IV. Provider business mailing address

6335 S EAST ST
INDIANAPOLIS IN
46227-7112
US

V. Phone/Fax

Practice location:
  • Phone: 317-780-1610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39004543A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: