Healthcare Provider Details

I. General information

NPI: 1285465716
Provider Name (Legal Business Name): RACHEL LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 PENN AVE STE 305
WYOMISSING PA
19610-2100
US

IV. Provider business mailing address

622 RESERVE WAY
TEMPLE PA
19560-9210
US

V. Phone/Fax

Practice location:
  • Phone: 717-288-9951
  • Fax:
Mailing address:
  • Phone: 215-407-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: RACHEL WATERMAN
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: M.ED, LPC
Phone: 215-407-4084