Healthcare Provider Details

I. General information

NPI: 1548745748
Provider Name (Legal Business Name): RACHAEL GARNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 I 55 N STE 264A
JACKSON MS
39211-5930
US

IV. Provider business mailing address

4500 I 55 N STE 264A
JACKSON MS
39211-5930
US

V. Phone/Fax

Practice location:
  • Phone: 769-208-5809
  • Fax:
Mailing address:
  • Phone: 769-208-5809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2570
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: