Healthcare Provider Details

I. General information

NPI: 1447262761
Provider Name (Legal Business Name): RACHEL MINTON LOUT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4632 NE STALLINGS DR STE 300
NACOGDOCHES TX
75965-1608
US

IV. Provider business mailing address

310 CR 1291
NACOGDOCHES TX
75965
US

V. Phone/Fax

Practice location:
  • Phone: 936-558-6250
  • Fax: 936-558-6251
Mailing address:
  • Phone: 936-554-8007
  • Fax: 936-598-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: