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General NPI Number Information
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NPI Number | 1891330585
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Entity Type | Individual
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Provider Name | RACHEL KENT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2019
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Last Update Date | 11/17/2019
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Provider Practice Location Address
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Address Line | 6201 W MAIN ST
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City | MARYVILLE
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State | IL
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Zip | 62062-6870
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Country | US
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Telephone | 618-977-6252
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Fax |
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Provider Business Mailing Address
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Address Line | 904 STONE BRIAR DR
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City | O FALLON
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State | IL
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Zip | 62269-6981
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Country | US
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Telephone | 618-558-9035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.011908
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License Number State | IL
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