Healthcare Provider Details

I. General information

NPI: 1952727430
Provider Name (Legal Business Name): RACHA FARES PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 PASS RD
BILOXI MS
39531-3330
US

IV. Provider business mailing address

1746 PASS RD
BILOXI MS
39531-3330
US

V. Phone/Fax

Practice location:
  • Phone: 284-652-5242
  • Fax: 228-248-0020
Mailing address:
  • Phone: 284-652-5242
  • Fax: 228-248-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 8944
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number621130
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: