=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760067862
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL HARTSHORN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2021
-----------------------------------------------------
Last Update Date | 03/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2520 SAINT ROSE PKWY STE 306
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-7790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-487-7249
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2520 SAINT ROSE PKWY STE 306
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-7790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-487-7249
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 12619364-3904
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------