Healthcare Provider Details

I. General information

NPI: 1275468852
Provider Name (Legal Business Name): RACHELL TINGELSTAD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 S FOUNTAIN AVE
SPRINGFIELD OH
45506-2223
US

IV. Provider business mailing address

509 S FOUNTAIN AVE
SPRINGFIELD OH
45506-2223
US

V. Phone/Fax

Practice location:
  • Phone: 309-645-5291
  • Fax:
Mailing address:
  • Phone: 309-645-5291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2507547
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: