Healthcare Provider Details

I. General information

NPI: 1235687096
Provider Name (Legal Business Name): RACHEL CALLICOAT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 04/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 BRYAN DR
DURANT OK
74701-3462
US

IV. Provider business mailing address

553 B S CARR PEN RD
ATOKA OK
74525
US

V. Phone/Fax

Practice location:
  • Phone: 580-745-4049
  • Fax:
Mailing address:
  • Phone: 580-745-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6787
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: