Healthcare Provider Details

I. General information

NPI: 1639604010
Provider Name (Legal Business Name): RACHEL SANDERSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL TROKEY LPC

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 HILLTOP VILLAGE CENTER DR
EUREKA MO
63025-3922
US

IV. Provider business mailing address

97 HILLTOP VILLAGE CENTER DR
EUREKA MO
63025-3922
US

V. Phone/Fax

Practice location:
  • Phone: 314-374-1620
  • Fax:
Mailing address:
  • Phone: 314-374-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014042884
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: