=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962907881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RACHEL SCHULTZ COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2018
-----------------------------------------------------
Last Update Date | 09/22/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1639 N ALPINE RD STE 403
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61107-1440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-313-4714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1639 N ALPINE RD STE 403
-----------------------------------------------------
City | ROCKFORD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61107-1440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-313-4714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RACHEL SCHULTZ
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 608-313-4714
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.011514
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------