Healthcare Provider Details

I. General information

NPI: 1801057435
Provider Name (Legal Business Name): RACHEL ANGELA MORICI-LEIRER M.A., LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 TRIPP LAKE CAMP RD
POLAND ME
04274-7505
US

IV. Provider business mailing address

47 TRIPP LAKE CAMP RD
POLAND ME
04274-7505
US

V. Phone/Fax

Practice location:
  • Phone: 303-856-4414
  • Fax:
Mailing address:
  • Phone: 303-856-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5739
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC6222
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: