Healthcare Provider Details

I. General information

NPI: 1881220697
Provider Name (Legal Business Name): RACHEL MILLER SLOUGH PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 11/27/2023
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S DOSSETT DRIVE
JOHNSON CITY TN
37614
US

IV. Provider business mailing address

PO BOX 70649
JOHNSON CITY TN
37614-1702
US

V. Phone/Fax

Practice location:
  • Phone: 423-439-7777
  • Fax:
Mailing address:
  • Phone: 804-938-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3686
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3686
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number3686
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: