Healthcare Provider Details

I. General information

NPI: 1679549810
Provider Name (Legal Business Name): CAROL K RACHEOTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 N PARK RD
TEXARKANA TX
75503-2664
US

IV. Provider business mailing address

5221 N PARK RD
TEXARKANA TX
75503-2664
US

V. Phone/Fax

Practice location:
  • Phone: 903-791-1051
  • Fax: 903-791-1054
Mailing address:
  • Phone: 903-791-1051
  • Fax: 903-791-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10493
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP9204008
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number003155
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: