Healthcare Provider Details

I. General information

NPI: 1073825402
Provider Name (Legal Business Name): RACHEL ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 WEST 700 SOUTH
EPHRAIM UT
84627
US

IV. Provider business mailing address

110 E WALLACE AVE STE B
COEUR D ALENE ID
83814-2948
US

V. Phone/Fax

Practice location:
  • Phone: 425-283-4690
  • Fax: 435-283-4689
Mailing address:
  • Phone: 801-885-0557
  • Fax: 435-283-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7675492-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: