Healthcare Provider Details

I. General information

NPI: 1447749239
Provider Name (Legal Business Name): RACHELLE LIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 12/06/2020
Certification Date: 12/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12414 HIGHWAY 99 STE 209
EVERETT WA
98204-8511
US

IV. Provider business mailing address

14710 46TH AVE NE
MARYSVILLE WA
98271-6170
US

V. Phone/Fax

Practice location:
  • Phone: 360-453-7385
  • Fax:
Mailing address:
  • Phone: 360-453-7385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61088532
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: