Healthcare Provider Details

I. General information

NPI: 1306315015
Provider Name (Legal Business Name): RACHEL MICU MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 S 5TH ST STE 306
SAINT CHARLES MO
63301-2447
US

IV. Provider business mailing address

PO BOX 386
IMPERIAL MO
63052-0386
US

V. Phone/Fax

Practice location:
  • Phone: 636-746-9285
  • Fax: 636-224-1784
Mailing address:
  • Phone: 636-746-9285
  • Fax: 636-224-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2018045597
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2018045597
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: