=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710233218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY JOANN RACH MS, LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2012
-----------------------------------------------------
Last Update Date | 08/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17420 460TH ST
-----------------------------------------------------
City | VERNDALE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56481-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-924-2372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17420 460TH ST
-----------------------------------------------------
City | VERNDALE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56481-3119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-924-2372
-----------------------------------------------------
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 | CC00293
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------