=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578404059
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAQUEL NICHAELA ESCALANTE MA, LPC-A
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2026
-----------------------------------------------------
Last Update Date | 04/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2265 COMO AVE
-----------------------------------------------------
City | SAINT PAUL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55108-1737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-364-5977
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1906 8TH AVE APT B
-----------------------------------------------------
City | CANYON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79015-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-206-0556
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 89784
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------