Healthcare Provider Details

I. General information

NPI: 1003437864
Provider Name (Legal Business Name): RACHEL TYREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 WILLARD RD STE 105
RICHMOND VA
23294-3638
US

IV. Provider business mailing address

1640 E PARHAM RD
RICHMOND VA
23228-2368
US

V. Phone/Fax

Practice location:
  • Phone: 804-549-2376
  • Fax: 804-716-7186
Mailing address:
  • Phone: 40-285-9838
  • Fax: 804-285-9839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133001705
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: